scholarly journals Contralesional Structural Plasticity in Different Molecular Pathologic Subtypes of Insular Glioma

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhenxing Huang ◽  
Gen Li ◽  
Zhenye Li ◽  
Shengjun Sun ◽  
Yazhuo Zhang ◽  
...  
Keyword(s):  
Histological Grade ◽  
Gray Matter Volume ◽  
Three Dimensional ◽  
Region Of Interest ◽  
High Grade Glioma ◽  
Low Grade ◽  
Idh Mutation ◽  
Wild Type ◽  
Promoter Mutation ◽  
1P19q Codeletion

Neuroplasticity may preserve neurologic function in insular glioma, thereby improving prognosis following resection. However, the anatomic and molecular bases of this phenomenon are not known. To address this gap in knowledge, the present study investigated contralesional compensation in different molecular pathologic subtypes of insular glioma by high-resolution three-dimensional T1-weighted structural magnetic resonance imaging. A total of 52 patients with insular glioma were examined. We compared the gray matter volume (GMV) of the contralesional insula according to histological grade [low-grade glioma (LGG) and high-grade glioma (HGG)] and molecular pathology status [isocitrate dehydrogenase (IDH) mutation, telomerase reverse-transcriptase (TERT) promoter mutation, and 1p19q codeletion] by voxel-based morphometry (VBM). A cluster of 320 voxels in contralesional insula with higher GMV was observed in glioma with IDH mutation as compared to IDH wild-type tumors by region of interest-based VBM analysis (family-wise error-corrected at p < 0.05). The GMV of the entire contralesional insula was also larger in insular glioma patients with IDH mutation than in patients with wild-type IDH. However, there was no association between histological grade, TERT promoter mutation, or 1p19q codeletion and GMV in the contralesional insula. Thus, IDH mutation is associated with greater structural compensation in insular glioma. These findings may be useful for predicting neurocognitive and functional outcomes in patients undergoing resection surgery.

scholarly journals P04.14 Loss of oligodendroglial features at recurrence in five diffuse low-grade glioma patients treated with repeated surgery

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii31-iii32
Author(s):  
A Darlix ◽  
H Duffau ◽  
V Rigau ◽  
C Gozé
Keyword(s):  
Tumor Volume ◽  
Biological Data ◽  
Low Grade ◽  
Idh Mutation ◽  
Genetic Analyses ◽  
Continuous Growth ◽  
1P19q Codeletion ◽  
Tert Promoter ◽  
Second Surgery ◽  
Repeated Surgery

Abstract BACKGROUND Diffuse low-grade gliomas (DLGG) are characterized by a continuous growth and an unavoidable anaplastic transformation. IDH mutation and 1p19q codeletion have been integrated to the 2016 WHO classification to define the oligodendroglioma entity. Whenever feasible, neurosurgical resection is the first treatment option. At recurrence, a second surgical resection is proposed in selected cases. The consistency of molecular patterns (IDH mutation, 1p19q codeletion) at recurrence has been poorly studied in DLGG. MATERIAL AND METHODS We conducted a retrospective study on consecutive DLGG patients treated at our institution with repeated surgery (2006–2017). Clinical and biological data were collected for both the initial and subsequent surgery. Additional immunohistochemistry (including tumor morphology, ATRX and p53) and genetic analyses (TERT promoter mutation, CIC mutation, CGHa) were also performed on tumors with joint loss of IDH mutation and of 1p19q codeletion at recurrence. RESULTS A total of 71 patients were identified. Analyses were carried out on 56 patients (molecular data missing: n=15). Nine patients (16.1%) presented with a loss of their IDH mutation at second surgery. Five of them (8.9%) had an additional loss of their 1p19q codeletion. These five cases (3 men, median age 36.6 years) were all treated with surgery as the first oncological treatment. The first surgery revealed in all cases tumors with morphological oligodendroglial features, IDH mutation and 1p19q codeletion. Further molecular analysis strengthened the diagnosis of oligodendroglioma (TERT promoter and CIC mutations, no ATRX loss, no expression of p53). Four patients were followed-up after the first surgery; one patient received Temozolomide 14 months later due to FLAIR tumor volume growth. Because of the regrowth of the residual FLAIR tumor volume, a second surgery was performed in all patients, after a median time of 38.9 months. The morphological oligodendroglial features were lost, and the genetic analyses revealed in all cases no IDH mutation, no 1p19q codeletion, no ATRX loss and no expression of p53. No evidence of anaplasia was found histologically or by CGHa analysis in these recurrent tumors. CONCLUSION We describe five DLGG patients with a shared histo-molecular evolution characterized by the loss of the initial IDH mutation and of oligodendroglial features at second surgery. While rare, this possible evolution must be acknowledged as it can impact the subsequent therapeutic strategy. This observation is the first of a loss of founder alterations in DLGG genesis (i.e. IDH mutation and 1p19q codeletion); the involved mechanism likely differs from the previously described oligoclonal selection caused by spontaneous tumor genetic drift and/or pressure of chemotherapy, and could be linked with the Darwinian selection of a subpopulation of tumor cells after the first surgery.

scholarly journals A functional MRI study of presurgical cognitive deficits in glioma patients

2020 ◽  
Author(s):  
Irena T Schouwenaars ◽  
Miek J de Dreu ◽  
Geert-Jan M Rutten ◽  
Nick F Ramsey ◽  
Johan M Jansma
Keyword(s):  
Functional Mri ◽  
Cognitive Deficits ◽  
Brain Activity ◽  
Neuropsychological Testing ◽  
Region Of Interest ◽  
High Grade Glioma ◽  
Brain Regions ◽  
Brain State ◽  
Low Grade ◽  
Activity Levels

Abstract Background The main goal of this functional MRI (fMRI) study was to examine whether cognitive deficits in glioma patients prior to treatment are associated with abnormal brain activity in either the central executive network (CEN) or default mode network (DMN). Methods Forty-six glioma patients, and 23 group-matched healthy controls (HCs) participated in this fMRI experiment, performing an N-back task. Additionally, cognitive profiles of patients were evaluated outside the scanner. A region of interest–based analysis was used to compare brain activity in CEN and DMN between groups. Post hoc analyses were performed to evaluate differences between low-grade glioma (LGG) and high-grade glioma (HGG) patients. Results In-scanner performance was lower in glioma patients compared to HCs. Neuropsychological testing indicated cognitive impairment in LGG as well as HGG patients. fMRI results revealed normal CEN activation in glioma patients, whereas patients showed reduced DMN deactivation compared to HCs. Brain activity levels did not differ between LGG and HGG patients. Conclusions Our study suggests that cognitive deficits in glioma patients prior to treatment are associated with reduced responsiveness of the DMN, but not with abnormal CEN activation. These results suggest that cognitive deficits in glioma patients reflect a reduced capacity to achieve a brain state necessary for normal cognitive performance, rather than abnormal functioning of executive brain regions. Solely focusing on increases in brain activity may well be insufficient if we want to understand the underlying brain mechanism of cognitive impairments in patients, as our results indicate the importance of assessing deactivation.

scholarly journals Low grade glioma patients with IDH mutation and 1p19q codeletion: What to do after surgery?

2017 ◽  
Vol 28 ◽  
pp. v110
Author(s):  
E. Franceschi ◽  
A. Mura ◽  
A. Mandrioli ◽  
S. Minichillo ◽  
A. Tosoni ◽  
...  
Keyword(s):  
Low Grade Glioma ◽  
Low Grade ◽  
Idh Mutation ◽  
1P19q Codeletion

scholarly journals Efficiency of High and Standard b Value Diffusion-Weighted Magnetic Resonance Imaging in Grading of Gliomas

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Mansour Al-Agha ◽  
Khaled Abushab ◽  
Khetam Quffa ◽  
Samy Al-Agha ◽  
Yasser Alajerami ◽  
...  
Keyword(s):  
Preoperative Evaluation ◽  
Area Under The Curve ◽  
Region Of Interest ◽  
High Grade Glioma ◽  
B Value ◽  
Response To Therapy ◽  
Low Grade ◽  
Roc Curve Analysis ◽  
Diffusion Weighted ◽  
Adc Values

Background. Glioma is the most common fatal malignant tumor of the CNS. Early detection of glioma grades based on diffusion-weighted imaging (DWI) properties is considered one of the most recent noninvasive promising tools in the assessment of glioma grade and could be helpful in monitoring patient prognosis and response to therapy. Aim. This study aimed to investigate the accuracy of DWI at both standard and high b values (b = 1000 s/mm2 and b = 3000 s/mm2) to distinguish high-grade glioma (HGG) from low-grade glioma (LGG) in clinical practice based on histopathological results. Materials and Methods. Twenty-three patients with glioma had DWI at l.5 T MR using two different b values (b = 1000 s/mm2 and b = 3000 s/mm2) at Al-Shifa Medical Complex after obtaining ethical and administrative approvals, and data were collected from March 2019 to March 2020. Minimum, maximum, and mean of apparent diffusion coefficient (ADC) values were measured through drawing region of interest (ROI) on a solid part at ADC maps. Data were analyzed by using the MedCalc analysis program, version 19.0.4, receiver operating characteristic (ROC) curve analysis was done, and optimal cutoff values for grading gliomas were determined. Sensitivity and specificity were also calculated. Results. The obtained results showed the ADCmean, ADCratio, ADCmax, and ADCmin were performed to differentiate between LGG and HGG at both standard and high b values. Moreover, ADC values were inversely proportional to glioma grade, and these differences are more obvious at high b value. Minimum ADC values using standard b value were 1.13 ± 0.17 × 10−3 mm2/s, 0.89 ± 0.85 × 10−3 mm2/s, and 0.82 ± 0.17 × 10−3 mm2/s for grades II, III, and IV, respectively. Concerning high b value, ADCmin values were 0.76 ± 0.07 × 10−3 mm2/s, 0.61 ± 0.01 × 10−3 mm2/s, and 0.48 ± 0.07 × 10−3 mm2/s for grades II, III, and IV, respectively. ADC values were inversely correlated with results of glioma grades, and the correlation was stronger at ADC3000 (r = −0.722, P≤0.001). The ADC3000 achieved the highest diagnostic accuracy with an area under the curve (AUC) of 0.618, 100% sensitivity, 85.7% specificity, and 85.7% accuracy for glioma grading at a cutoff point of ≤0.618 × 10−3 mm2/s. The high b value showed stronger agreement with histopathology compared with standard b value results (k = 0.89 and 0.79), respectively. Conclusion. The ADC values decrease with an increase in tumor cellularity. Meanwhile, high b value provides better tissue contrast by reflecting more tissue diffusivity. Therefore, ADC-derived parameters at high b value are more useful in the grading of glioma than those obtained at standard b value. They might be a better surrogate imaging sequence in the preoperative evaluation of gliomas.

Low grade glioma patients with IDH mutation and 1p19q codeletion: To treat or not to treat?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2017-2017 ◽  
Author(s):  
Enrico Franceschi ◽  
Dario De Biase ◽  
Alexandro Paccapelo ◽  
Antonella Mura ◽  
Alicia Tosoni ◽  
...  
Keyword(s):  
Extent Of Resection ◽  
Low Grade ◽  
Incomplete Resection ◽  
Idh Mutation ◽  
1P19q Codeletion ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Surgical Treatments

2017 Background: Molecular characterization of low grade gliomas (LGG) is essential for diagnosis and treatment of these diseases. LGG patients (pts) with IDH mutation and 1p19q codeletion (codel) are characterized by a median OS (mOS) longer than 10 years. Thus, the role of treatments and side effects should be carefully evaluated. Methods: We evaluated LGG pts from our data warehouse (n=679 pts) who received surgery and had sufficient tissue to assess biomarkers characterization. Pts with gliomatosis were excluded. IDH1/2 assessment was performed on formalin-fixed paraffin-embedded samples by qPCR. In wild type cases we performed NGS. 1p/19 codel analysis was performed by FISH. Results: 93 consecutive LGG with IDH mutation and codel were included. The median follow up (FU) was 96.1 months. Mean age was 40 yrs (range: 25-66); 8 pts (8.6%) underwent biopsy, 61 pts (65.6%) partial resection, 24 pts (25.8%) complete resection. 84 pts (90.3%) were considered high risk using RTOG criteria (>40 years and/or incomplete resection). Fifty pts (53.7%) received only FU, 17 pts (18.3%) received chemotherapy (CT), 18 pts (19.4%) received radiotherapy (RT), 8 pts (8.6%) received RT + CT. Median PFS (mPFS) was 59.6 months (95%CI: 41.8-77.4) and was significantly longer in pts who received postsurgical treatments (79.5 months, 95%CI: 66.4-92.7) than pts who received FU (46.3 months, 95%CI: 36.0-56.5; P=0.001). mPFS was 50.8 months (95%CI: 17.4-84.3), 103.6 months (95%CI: 11.7-195.6) and 120.2 months (95%CI: 40.5-199.8) in pts treated with CT alone, RT alone and RT + CT, respectively. Multivariate analysis showed that receiving a post-surgical treatment (P<0.001), and the extent of resection (P=0.043) were significantly correlated with PFS. Conclusions: Our study evaluated the role of treatments in LGG pts assessed with NGS and FISH. Post-surgical treatments are crucial to extend PFS in pts with IDH mutation and codel. The choice of post-surgical treatments seems to have a role, being CT alone less effective than RT and RT+CT. Longer FU is needed to provide information about OS.

IDH mutation and 1p19q codeletion distinguish two radiological patterns of diffuse low-grade gliomas

2017 ◽  
Vol 133 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Amélie Darlix ◽  
Jérémy Deverdun ◽  
Nicolas Menjot de Champfleur ◽  
Florence Castan ◽  
Sonia Zouaoui ◽  
...  
Keyword(s):  
Low Grade ◽  
Idh Mutation ◽  
Low Grade Gliomas ◽  
1P19q Codeletion ◽  
Radiological Patterns

scholarly journals Relación Entre El Coeficiente De Difusión Aparente y la celularidad. [Relación Entre El Coeficiente De Difusión Aparente yLa Celularidad De Gliomas en Centro de tercer nivel de Panamá]

2020 ◽  
Vol 40 (1) ◽  
Author(s):  
José María Barría Castro ◽  
Linamar Antuaneth Caballero Vega ◽  
Javier Augusto Pimentel Sández ◽  
Fernando Miguel Sucre Grimaldo
Keyword(s):  
Magnetic Resonance ◽  
Malignant Tumors ◽  
Histological Grade ◽  
Statistical Significance ◽  
Region Of Interest ◽  
Low Grade ◽  
High Grade ◽  
Anatomic Site ◽  
Adc Values ◽  
High Grade Gliomas

<p>Resumen<br /><br />Introducción: Los gliomas son tumores malignos altamente celulares del sistema nervioso central. Su grado histológico preoperatorio es de utilidad en el manejo quirúrgico, por lo que la resonancia magnética con secuencias avanzadas intenta brindar mayor información tumoral.  <br />Objetivo: Relacionar el coeficiente aparente de difusión (CAD) y celularidad de los gliomas de pacientes entre enero 2015 a diciembre 2017.</p><p><br />Metodología:Retrospectivamente se obtuvieron de archivos clínicos la edad, sexo, tipo, grado histológicoy sitio anatómico. Se calculó el CAD en 5mm2 en los estudios de resonancia magnética preoperatorias y se utilizó las laminillas para conteo de celularidad en 5mm2 digitalmente. Se utilizó análisis estadísticos descriptivos y coeficiente de correlación entre CDA con celularidad. Se utilizaron valores de p &lt; 0.05 para significancia estadística.<br />Resultados: 46 casos fueron incluidos, 56.5% fueron hombres. El rango de 41-64 años fueron los más afectados. El glioblastoma fue el tipo histológico más frecuente (47.8%), así como los gliomas de alto grado (73.9%). El 95.7% fueron supratentoriales. La celularidad promedio fue de 3970 ± 2900 vs 2436 ± 948 núcleos/5mm2 (p = 0.13), con valores promedio de CDA mínimo de 0.813 x 10-3 ± 0.229 mm2/s vs 1.052 x 10-3 ± 0.196 mm2/s (p = 0.002), para los gliomas de alto y bajo grado respectivamente. La correlación entre CDA y celularidad fue débil (R = - 0.13, p = 0.37).</p><p><br />Conclusión: Existe correlación débil inversamente proporcional entre el CDA y la celularidad con distinción de gliomas de bajo y alto grado con valores de CDA mínimos.<br /><br /> <br />Abstract<br />Introduction: Gliomas are highly cellular malignant tumors of the central nervous system. Itspreoperative histological grade is useful in surgical management,so magnetic resonance imaging with advanced sequences tries to provide more tumor information.</p><p><br />Objective:Correlateapparent diffusion coefficient (ADC) and cellularity of gliomas of patients between January 2015 to December 2017.<br />Methodology:Data of age, sex, type, histologic grade and anatomic site were retrospectively obtained from clinical archives.The preoperative magnetic resonance ADC was calculated in a 5 mm2 region of interest and the microscope slides were used for the cellularity digitally count in 5 mm2. Descriptive statistical analysis and correlation coefficient between ADC and cellularity were used. Values of p &lt;0.05 were used for statistical significance.</p><p><br />Results: 46 cases were included, 56.5% were men. The 41-64 years ranges were the most affected. Glioblastoma was the most frequent histological type (47.8%), as well as high grade gliomas (73.9%). 95.7% were supratentorial. The average cellularity was 3970 ± 2900 vs 2436 ± 948 nuclei/ 5mm2 (p = 0.13), with average minimum ADC values of 0.813 x 10-3 ± 0.229 mm2/s vs 1052 x 10-3 ± 0.196 mm2/s (p = 0.002), for high- and low-grade gliomas, respectively. The correlation between ADC and cellularity was weak (R = - 0.13, p = 0.37).</p><p><br />Conclusions:There is a weak inversely proportional correlation between ADC and cellularity. With distinction of low- and high-grade gliomas with minimum ADC values.<br /><br /></p>

scholarly journals Pharmacoresistant seizures and IDH mutation in low grade gliomas

2021 ◽  
Author(s):  
Carlos Eduardo Correia ◽  
Yoshie Umemura ◽  
Jessica R Flynn ◽  
Anne S Reiner ◽  
Edward K Avila
Keyword(s):  
Tumor Resection ◽  
Incidence Rates ◽  
P Value ◽  
Low Grade ◽  
Idh Mutation ◽  
Wild Type ◽  
Mutation Status ◽  
Low Grade Gliomas ◽  
Idh1 R132h ◽  
Idh Mutations

Abstract Purpose Many low-grade gliomas (LGG) harbor isocitrate dehydrogenase (IDH) mutations. Although IDH mutation is known to be epileptogenic, the rate of refractory seizures in LGG with IDH mutation vs wild-type had not been previously compared. We therefore compared seizure pharmacoresistance in IDH-mutated and wild-type LGGs. Methods Single-institution retrospective study of patients with histologic proven LGG, known IDH mutation status, seizures, and ≥ 2 neurology clinic encounters. Seizure history was followed until histological high-grade transformation or death. Seizures requiring ≥ 2 changes in anti-epileptic drugs were considered pharmacoresistant. Incidence rates of pharmacoresistant seizures were estimated using competing risks methodology. Results Of 135 patients, 25 patients (19%) had LGGs classified as IDH wild-type. Of those with IDH mutation, 104 (94.5%) were IDH1 R132H; only six were IDH2 R172K. 120 patients (89%) had tumor resection and 14 (10%) had biopsy. Initial post-surgical management included observation (64%), concurrent chemoradiation (23%), chemotherapy alone (9%), and radiotherapy alone (4%). Seizures became pharmacoresistant in 24 IDH-mutated patients (22%) and in 3 IDH wild-type patients (12%). The 4-year cumulative incidence of intractable seizures was 17.6% (95% CI: 10.6%-25.9%) in IDH-mutated and 11% (95% CI: 1.3%-32.6%) in IDH wild-type LGG (Gray’s P-value= 0.26). Conclusions 22% of the IDH-mutated patients developed pharmacoresistant seizures, compared to 12% of the IDH wild-type tumors.The likelihood of developing pharmacoresistant seizures in patients with LGG-related epilepsy is independent to IDH mutation status, however, IDH-mutated tumors were approximately twice as likely to experience LGG-related pharmacoresistant seizures.

scholarly journals Metabolic approach for tumor delineation in glioma surgery: 3D MR spectroscopy image–guided resection

2016 ◽  
Vol 124 (6) ◽  
pp. 1585-1593 ◽  
Author(s):  
Jie Zhang ◽  
Dong-Xiao Zhuang ◽  
Cheng-Jun Yao ◽  
Ching-Po Lin ◽  
Tian-Liang Wang ◽  
...  
Keyword(s):  
Mr Spectroscopy ◽  
Tumor Resection ◽  
Three Dimensional ◽  
High Grade Glioma ◽  
Radiotherapy Planning ◽  
Low Grade ◽  
Structural Imaging ◽  
Glioma Surgery ◽  
Extensive Resection ◽  
Glioma Resection

OBJECT The extent of resection is one of the most essential factors that influence the outcomes of glioma resection. However, conventional structural imaging has failed to accurately delineate glioma margins because of tumor cell infiltration. Three-dimensional proton MR spectroscopy (1H-MRS) can provide metabolic information and has been used in preoperative tumor differentiation, grading, and radiotherapy planning. Resection based on glioma metabolism information may provide for a more extensive resection and yield better outcomes for glioma patients. In this study, the authors attempt to integrate 3D 1H-MRS into neuronavigation and assess the feasibility and validity of metabolically based glioma resection. METHODS Choline (Cho)–N-acetylaspartate (NAA) index (CNI) maps were calculated and integrated into neuronavigation. The CNI thresholds were quantitatively analyzed and compared with structural MRI studies. Glioma resections were performed under 3D 1H-MRS guidance. Volumetric analyses were performed for metabolic and structural images from a low-grade glioma (LGG) group and high-grade glioma (HGG) group. Magnetic resonance imaging and neurological assessments were performed immediately after surgery and 1 year after tumor resection. RESULTS Fifteen eligible patients with primary cerebral gliomas were included in this study. Three-dimensional 1H-MRS maps were successfully coregistered with structural images and integrated into navigational system. Volumetric analyses showed that the differences between the metabolic volumes with different CNI thresholds were statistically significant (p < 0.05). For the LGG group, the differences between the structural and the metabolic volumes with CNI thresholds of 0.5 and 1.5 were statistically significant (p = 0.0005 and 0.0129, respectively). For the HGG group, the differences between the structural and metabolic volumes with CNI thresholds of 0.5 and 1.0 were statistically significant (p = 0.0027 and 0.0497, respectively). All patients showed no tumor progression at the 1-year follow-up. CONCLUSIONS This study integrated 3D MRS maps and intraoperative navigation for glioma margin delineation. Optimum CNI thresholds were applied for both LGGs and HGGs to achieve resection. The results indicated that 3D 1H-MRS can be integrated with structural imaging to provide better outcomes for glioma resection.

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