Revisiting anaplastic astrocytomas I: An expansive growth pattern is associated with a better prognosis

Moulding, Hugh D.; Friedman, David P.; Curtis, Mark; Kenyon, Lawrence C.; Flanders, Adam E.; Paek, Sun Ha; Andrews, David W.

doi:10.1002/jmri.21593

Cited by 12 publications

(9 citation statements)

References 37 publications

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“…Cells with M2 phenotype markers are also generally detectable in AIII tumors, albeit at a lower level than is evident for glioblastoma multiforme and with greater variability in IL-10 expression. Consistent with our previous observation of distinct radiographic phenotypes within grade III astrocytomas that differ in prognosis (41), AIII tumors also segregate into three groups by IL-10 and M2 marker expression: (i) neither IL-10 nor M2 markers, (ii) M2 phenotypic markers but low levels of IL-10, and (iii) high levels of both M2 markers and IL-10. Like the first AIII subset, cells with an M2 phenotype are rare in grade II astrocytomas, which rarely express significant levels of IL-10.…”

Section: Discussionsupporting

confidence: 90%

Glioma Grade Is Associated with the Accumulation and Activity of Cells Bearing M2 Monocyte Markers

Prosniak

Harshyne

Andrews

et al. 2013

Clinical Cancer Research

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167

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Purpose: This study is directed at identifying the cell source(s) of immunomodulatory cytokines in highgrade gliomas and establishing whether the analysis of associated markers has implications for tumor grading.Experimental Design: Glioma specimens classified as WHO grade II-IV by histopathology were assessed by gene expression analysis and immunohistochemistry to identify the cells producing interleukin (IL)-10, which was confirmed by flow cytometry and factor secretion in culture. Finally, principal component analysis (PCA) and mixture discriminant analysis (MDA) were used to investigate associations between expressed genes and glioma grade.Results: The principle source of glioma-associated IL-10 is a cell type that bears phenotype markers consistent with M2 monocytes but does not express all M2-associated genes. Measures of expression of the M2 cell markers CD14, CD68, CD163, and CD204, which are elevated in high-grade gliomas, and the neutrophil/myeloid-derived suppressor cell (MDSC) subset marker CD15, which is reduced, provide the best index of glioma grade.Conclusions: Grade II and IV astrocytomas can be clearly differentiated on the basis of the expression of certain M2 markers in tumor tissues, whereas grade III astrocytomas exhibit a range of expression between the lower and higher grade specimens. The content of CD163 þ cells distinguishes grade III astrocytoma subsets with different prognosis.

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Section: Discussionsupporting

confidence: 90%

Glioma Grade Is Associated with the Accumulation and Activity of Cells Bearing M2 Monocyte Markers

Prosniak

Harshyne

Andrews

et al. 2013

Clinical Cancer Research

Self Cite

167

128

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“…In one case, an expansive growth pattern was further corroborated with multivoxel spectroscopy (Case 5, discussed below). These growth pattern groups recapitulated our earlier MR findings in the companion article (24). Table 2 summarizes the growth patterns of all patients studied by evaluating two perception criteria: fiber directionality, and fiber depth in the tumor.…”

Section: Resultssupporting

confidence: 75%

“…Based on our clinical experience, postoperative recovery and overall prognosis was significantly improved in the expansive subgroup of glioma patients (24), an observation recently corroborated by an article describing DTI-based functional neuronavigation (41). In the companion article, we associated prognostic significance with glioma growth patterns within the WHO Grade III classification.…”

Section: Discussionmentioning

confidence: 68%

“…Figures 4 -9 represent six cases, each representing one or two of the three different growth patterns origi-nally described by Scherer (36) (expansive, mixed, or infiltrative) and radiographically (24). We did not encounter any truly infiltrative tumors without obvious nidus in the course of this study, so cases were either mixed or expansive.…”

Section: Resultsmentioning

confidence: 81%

“…We excluded patients who were diagnosed with WHO Grade III tumors with an oligodendroglial component (23), as described in our companion analysis (24).…”

Section: Patient Populationmentioning

confidence: 99%

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Revisiting anaplastic astrocytomas II: Further characterization of an expansive growth pattern with visually enhanced diffusion tensor imaging

Guan

Lai

Lackey

et al. 2008

Magnetic Resonance Imaging

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Purpose: To seek to distinguish and visualize the different magnetic resonance imaging (MRI) growth patterns among malignant gliomas utilizing visually enhanced diffusion tensor imaging (DTI). Materials and Methods:Nineteen consecutive patients undergoing image-guided resection of a newly diagnosed malignant glioma underwent add-on acquisition of DTI data based on an Institutional Review Board (IRB)-approved imaging protocol during preoperative MRI scans for routine intraoperative image guidance. Tumor growth patterns were assigned to expansive or mixed/infiltrative classes as described in the companion article (24). Infiltrating tumors were WHO Grade IV astrocytomas and all expansive tumors were either WHO Grade III astrocytomas or WHO Grade II astrocytomas. DTI-based white matter tractography was conducted and the DTI data were fused with anatomical images using an in-house software package we developed to enhance the visualization of the tumor/fiber interface. In one case additional analysis was performed with 2D multivoxel 1 H-MRSI utilizing a 2D chemical shift imaging (CSI) technique to corroborate the nature of this interface.Results: Out of the 19 tumor patients studied, 11 had infiltrative tumors and the other 8 had expansive tumors. While less clear with 2D axial diffusion color maps, visually enhanced 3D reconstructions of the tumor/fiber interface successfully corroborated distinctive growth patterns. This was particularly evident when viewed in 3D video loops of each tumor/fiber interface. Conclusion:We have successfully developed software that visually enhances the anatomic details of the tumor/fiber interface in patients with anaplastic astrocytomas. These data support the existence of a subgroup of patients within the WHO Grade III classification with expansive tumors and a significantly better prognosis. DIFFUSION TENSOR IMAGING (DTI) can depict diffusivity and diffusion directionality of water molecules and allows for mapping white matter tracts in the brain (1-3). There has been strong interest in exploring the clinical applications of DTI, including assessment of brain tumors (4 -8). These studies mainly explored the use of quantitative diffusion measures (i.e., mean diffusivity, fractional anisotropy) derived from DTI. In our study we focused on distinguishing different tumor growth patterns by using visually enhanced DTI-based tractography to visualize the tumor/fiber interface in patients with anaplastic astrocytomas. To this end, novel DTI visualization techniques were developed in the form of user-friendly features in an in-house software that we describe herein.Many approaches have been investigated to assist in the visualization of DTI information. The simplest way was to display the DTI data projected onto 2D slices. The direction of the primary eigenvector was first projected onto a 2D plane, then color-coded, usually by mapping x, y, z components to RGB (red, green, and blue) (9,10). The brightness of such color maps are usually modulated by fractional anisotropy (FA). This method ca...

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Dynamic susceptibility contrast perfusion weighted imaging in grading of nonenhancing astrocytomas

Morita

Wang

Chawla

et al. 2010

Magnetic Resonance Imaging

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Purpose: To evaluate if the relative tumor blood volume (rTBV) using dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) can aid in distinguishing low-from high-grade nonenhancing astrocytomas. Materials and Methods:Seventeen patients with histologically proven astrocytomas underwent MRI including DSC-MRI. Maximum TBV regions of interest were recorded from each neoplasm and normalized to contralateral normal white matter. Demographic features, diagnostic MRI findings including tumor volumes, and the normalized rTBV ratios were compared between low-grade (I and II, LGA, n ¼ 6) and high-grade (III) astrocytomas (HGA, n ¼ 11) using Mann-Whitney's U-test and receiver operating characteristic (ROC) analysis.Results: Maximum rTBV ratios were statistically higher for HGA (1.11 6 0.13) than LGA (0.66 6 0.17, P < 0.005) with the best cutoff threshold at 0.94 (sensitivity of 90.9%, specificity of 100%). Differences in mean age and tumor volume on fluid-attenuated inversion recovery (FLAIR) imaging between the two groups did not reach statistical difference (P ¼ 0.22, 0.36). Conclusion:The addition of DSC-MRI can aid in accurate grading of nonenhancing astrocytomas with high sensitivity and specificity.

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Revisiting anaplastic astrocytomas I: An expansive growth pattern is associated with a better prognosis

Cited by 12 publications

References 37 publications

Glioma Grade Is Associated with the Accumulation and Activity of Cells Bearing M2 Monocyte Markers

Glioma Grade Is Associated with the Accumulation and Activity of Cells Bearing M2 Monocyte Markers

Revisiting anaplastic astrocytomas II: Further characterization of an expansive growth pattern with visually enhanced diffusion tensor imaging

Dynamic susceptibility contrast perfusion weighted imaging in grading of nonenhancing astrocytomas

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