Differentiation of high-grade and low-grade diffuse gliomas by intravoxel incoherent motion MR imaging

Gliomas grading is important for treatment plan; we aimed to investigate the application of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in gliomas grading, by comparing with the three-dimensional pseudocontinuous arterial spin labeling (3D pCASL). 24 patients (13 high grade gliomas and 11 low grade gliomas) underwent IVIM DWI and 3D pCASL imaging before operation; maps of fast diffusion coefficient (D∗), slow diffusion coefficient (D), fractional perfusion-related volume (f), and apparent diffusion coefficient (ADC) as well as cerebral blood flow (CBF) were calculated and then coregistered to generate the corresponding parameter values. We found CBF andD∗were higher in the high grade gliomas, whereas ADC,D, andfwere lower (allP<0.05). In differentiating the high from low grade gliomas, the maximum areas under the curves (AUC) ofD∗, CBF, and ADC were 0.857, 0.85, and 0.902, respectively. CBF was negatively correlated withfin tumor (r=-0.619,P=0.001). ADC was positively correlated withDin both tumor and white matter (r=0.887,P=0.000andr=0.824,P=0.000, resp.). There was no correlation between CBF andD∗in both tumor and white matter (P>0.05). IVIM DWI showed more efficiency than 3D pCASL but less validity than conventional DWI in differentiating the high from low grade gliomas.

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HGG-12. A CASE OF PEDIATRIC SPINAL HIGH-GRADE GLIOMA WITH NTRK1 GENE FUSION

Neuro-Oncology ◽

10.1093/neuonc/noaa222.301 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii346-iii346

Author(s):

Tamaki Morisako ◽

Daisuke Umebayashi ◽

Kazuaki Kamata ◽

Hiroyuki Yamamoto ◽

Takumi Yamanaka ◽

...

Keyword(s):

Spinal Cord ◽

Mr Imaging ◽

Tumor Progression ◽

Gene Fusion ◽

High Grade Glioma ◽

Gene Panel ◽

Partial Resection ◽

Low Grade ◽

High Grade ◽

Surgical Specimen

Abstract INTRODUCTION Tumors arising from the spinal cord are uncommon, especially high-grade tumors in pediatric patients. We report a case of high-grade glioma in the spinal cord harboring NTRK1 gene fusion, who received effective entrectinib therapy. CASE REPORT: A 5-year-old boy presented right hemiparesis and MR imaging revealed an intramedullary enhancing mass at the vertebral body level between C3 and Th1. He underwent microsurgical partial resection and the histological diagnosis was low-grade astrocytoma. After the first-line chemotherapy with vincristine and carboplatin, his right hemiparesis deteriorated and recurrent MR imaging showed growth of the tumor. He underwent microsurgical partial resection again and the histological examination was high-grade glioma with endothelial proliferation and necrosis. The chemoradiotherapy with temozolomide and focal irradiation of 50.4 Gy were given, and his neurological symptom slightly improved. One month later, he presented respiratory disturbance and required assisted ventilation with tracheostomy. MR imaging showed tumor progression invading upward to medulla oblongata. NTRK1 gene fusion was detected in the previous surgical specimen by a gene panel testing, and he received entrectinib, a potent inhibitor of tropomyosin receptor kinase (TRK). Since then, no tumor progression has been demonstrated for several months by MRI and he has been stable neurologically. CONCLUSION High-grade spinal cord tumors are rare and effective treatment strategies have not been addressed. Although the frequency of the gene fusion is very low in pediatric gliomas, identification of the driver gene aberration like in this case by a gene panel can provide potential targeted therapies for selected patients.

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Differentiation of High-Grade from Low-Grade Astrocytoma: Improvement in Diagnostic Accuracy and Reliability of Pharmacokinetic Parameters from DCE MR Imaging by Using Arterial Input Functions Obtained from DSC MR Imaging

Radiology ◽

10.1148/radiol.2017170764 ◽

2018 ◽

Vol 286 (3) ◽

pp. 981-991 ◽

Cited By ~ 5

Author(s):

Sung-Hye You ◽

Seung Hong Choi ◽

Tae Min Kim ◽

Chul-Kee Park ◽

Sung-Hye Park ◽

...

Keyword(s):

Mr Imaging ◽

Diagnostic Accuracy ◽

Pharmacokinetic Parameters ◽

Low Grade ◽

High Grade ◽

Arterial Input Functions

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Brainstem glioma: Prediction of histopathologic grade based on conventional MR imaging

The Neuroradiology Journal ◽

10.1177/1971400917743099 ◽

2017 ◽

Vol 31 (1) ◽

pp. 10-17 ◽

Cited By ~ 4

Author(s):

Yashar Moharamzad ◽

Morteza Sanei Taheri ◽

Farhad Niaghi ◽

Elham Shobeiri

Keyword(s):

Logistic Regression ◽

Mr Imaging ◽

Contrast Enhancement ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Low Grade ◽

Imaging Features ◽

High Grade ◽

Post Contrast ◽

Mri Features

Objective The objective of this article is to investigate the association between specific MR imaging findings and histopathologic grading (low-grade vs. high-grade) of brainstem gliomas (BSGs). Methods Sixty-two males and 34 females (mean (standard deviation, SD) age of 24.61 (17.20) years, range = 3 to 70 years) with histologically diagnosed BSG underwent conventional 1.5 T MR imaging, which included T1-weighted (T1W), T2W, and post-contrast T1W sequences. There were 39 children (mean age of 9.38 years) and 57 adults (mean age of 35 years). A binary logistic regression analysis was used to explore associations between MRI features and histopathological grade of the BSG. Results Binary logistic regression revealed that necrosis (adjusted odds ratio (OR) = 16.07; 95% confidence interval (CI) = 3.20 to 80.52; p = 0.001) and inhomogeneous contrast enhancement (adjusted OR = 8.04; 95% CI = 1.73 to 37.41; p = 0.008) as significant predictors of high-grade BSG. The equation (Nagelkerke R2 = 0.575) is Logit ( p high-grade BSG) = (2.77 × necrosis) + (2.08 × heterogeneous contrast enhancement) – 3.13. Sensitivity and specificity values were respectively 66.7% and 96.0% for necrosis and 85.7% and 65.9% for inhomogeneous contrast-enhancing lesions. In the pediatric age group, only inhomogeneous contrast enhancement (adjusted OR = 40; 95% CI = 3.95 to 445.73; p = 0.002) was a significant predictor for high-grade BSG. Conclusion Conventional MR imaging features such as necrosis and inhomogeneous contrast enhancement in adults and heterogeneous contrast enhancement in children suggest high-grade BSG.

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Temozolomide-induced hypermutation is associated with high-grade transformation, distant recurrence, and reduced survival after transformation in initially low-grade IDH-mutant diffuse gliomas.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2506 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2506-2506

Author(s):

Nancy Ann Oberheim Bush ◽

Yao Yu ◽

Javier Villanueva-Meyer ◽

Matthew Grimmer ◽

Stephanie Hilz ◽

...

Keyword(s):

Somatic Hypermutation ◽

Molecular Subtype ◽

Distant Recurrence ◽

Clinical Implications ◽

Low Grade ◽

High Grade ◽

Who Grade ◽

Low Grade Gliomas ◽

Diffuse Gliomas ◽

High Grade Transformation

2506 Background: Temozolomide, a commonly used alkylating agent to treat gliomas, can induce somatic hypermutation. The prevalence and clinical implications of this phenomenon are not well characterized. Methods: We used targeted and whole exome sequencing from a cohort of 82 patients with recurrent IDH-mutant low grade gliomas undergoing re-operation to evaluate the prevalence as well as the clinical implications of hypermutation. Results: Hypermutation was identified at transformation in 57% of recurrent gliomas exposed to Temozolomide, 94% of which were transformed to higher WHO grades. All patients who developed hypermutation were exposed to Temozolomide. Hypermutation was associated with transformation to higher WHO grade (OR 12.0 95% CI 2.5 – 115.5, p = 0.002) and shorter survival after transformation (HR 2.1, 95% CI 1.1-4.0, p = 0.018) compared with non-hypermutated transformed tumors, controlling for grade, molecular subtype, age, and prior radiotherapy. Patients with transformation to glioblastoma had poor survival regardless of hypermutation (p = 0.78). Hypermutated tumors were associated with development of discontiguous disease at a significantly higher frequency (p = 0.003), including four cases with spinal dissemination. Conclusions: TMZ-induced hypermutation is associated with high grade transformation, unique patterns of dissemination and shortened survival after transformation. Next generation sequencing should be considered in this patient population. These data have important implications for the management of newly diagnosed and recurrent IDH-mutant low grade gliomas.

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Utility of intravoxel incoherent motion magnetic resonance imaging and arterial spin labeling for recurrent glioma after bevacizumab treatment

Acta Radiologica ◽

10.1177/0284185118759707 ◽

2018 ◽

Vol 59 (11) ◽

pp. 1372-1379 ◽

Cited By ~ 2

Author(s):

Fuminori Miyoshi ◽

Yuki Shinohara ◽

Atsushi Kambe ◽

Keita Kuya ◽

Atsushi Murakami ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Diffusion Coefficient ◽

Magnetic Resonance ◽

Tumor Progression ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

Intravoxel Incoherent Motion ◽

Low Grade ◽

High Grade ◽

Resonance Imaging

Background Detecting recurrence of glioma on magnetic resonance imaging (MRI) is getting more and more important, especially after administration of new anti-tumor agent. However, it is still hard to identify. Purpose To examine the utility of intravoxel incoherent motion (IVIM) MRI and arterial spin labeling-cerebral blood flow (ASL-CBF) for recurrent glioma after initiation of bevacizumab (BEV) treatment. Material and Methods Thirteen patients (7 men, 6 women; age range = 41–82 years) with glioma (high grade, n = 11; low grade, n = 2) were enrolled in the study. IVIM parameters including apparent diffusion coefficient (ADC), true diffusion coefficient (D), and perfusion fraction (f) were obtained with 14 different b-values. We identified tumor progression during BEV therapy by MRI monitoring consisting of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR) imaging, and contrast-enhanced T1-weighted (CE-T1W) imaging by measuring tumor area. We also measured each parameter of IVIM and ASL-CBF, and calculated relative ADC (rADC), relative D (rD), relative f (rf), and relative CBF (rCBF) by obtaining the ratio between each area and the contralateral cerebral white matter. We calculated the rate of change (Δ) by subtracting values from those from the preceding MRI study, and obtained Spearman’s rank correlation coefficient (rs). Results Tumor progression was identified in nine patients (high grade, n = 7; low grade, n = 2). Negative correlations were identified between ΔrD and ΔDWI area (rs = –0.583), and between ΔrD and ΔCE-T1W imaging area (rs = –0.605). Conclusion Tumor progression after BEV treatment can be identified by decreasing rD.

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Comparison of Permeability in High-Grade and Low-Grade Brain Tumors Using Dynamic Susceptibility Contrast MR Imaging

American Journal of Roentgenology ◽

10.2214/ajr.178.3.1780711 ◽

2002 ◽

Vol 178 (3) ◽

pp. 711-716 ◽

Cited By ~ 157

Author(s):

James M. Provenzale ◽

Gin R. Wang ◽

Thomas Brenner ◽

Jeffrey R. Petrella ◽

A. Gregory Sorensen

Keyword(s):

Brain Tumors ◽

Mr Imaging ◽

Low Grade ◽

Dynamic Susceptibility ◽

High Grade ◽

Dynamic Susceptibility Contrast ◽

Susceptibility Contrast

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Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma—a meta-analysis

Neuro-Oncology ◽

10.1093/neuonc/noy095 ◽

2018 ◽

Vol 20 (11) ◽

pp. 1450-1461 ◽

Cited By ~ 4

Author(s):

Alberto Falk Delgado ◽

Francesca De Luca ◽

Danielle van Westen ◽

Anna Falk Delgado

Keyword(s):

Mr Imaging ◽

Arterial Spin Labeling ◽

Diagnostic Performance ◽

Meta Analysis ◽

Spin Labeling ◽

Low Grade Glioma ◽

Cochrane Library ◽

Low Grade ◽

High Grade ◽

Operating Characteristics

Abstract Background Arterial spin labeling is an MR imaging technique that measures cerebral blood flow (CBF) non-invasively. The aim of the study is to assess the diagnostic performance of arterial spin labeling (ASL) MR imaging for differentiation between high-grade glioma and low-grade glioma. Methods Cochrane Library, Embase, Medline, and Web of Science Core Collection were searched. Study selection ended November 2017. This study was prospectively registered in PROSPERO (CRD42017080885). Two authors screened all titles and abstracts for possible inclusion. Data were extracted independently by 2 authors. Bivariate random effects meta-analysis was used to describe summary receiver operating characteristics. Trial sequential analysis (TSA) was performed. Results In total, 15 studies with 505 patients were included. The diagnostic performance of ASL CBF for glioma grading was 0.90 with summary sensitivity 0.89 (0.79–0.90) and specificity 0.80 (0.72–0.89). The diagnostic performance was similar between pulsed ASL (AUC 0.90) with a sensitivity 0.85 (0.71–0.91) and specificity 0.83 (0.69–0.92) and pseudocontinuous ASL (AUC 0.88) with a sensitivity 0.86 (0.79–0.91) and specificity 0.80 (0.65–0.87). In astrocytomas, the diagnostic performance was 0.89 with sensitivity 0.86 (0.79 to 0.91) and specificity 0.79 (0.63 to 0.89). Sensitivity analysis confirmed the robustness of the findings. TSA revealed that the meta-analysis was adequately powered. Conclusion Arterial spin labeling MR imaging had an excellent diagnostic accuracy for differentiation between high-grade and low-grade glioma. Given its low cost, non-invasiveness, and efficacy, ASL MR imaging should be considered for implementation in the routine workup of patients with glioma.

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