Association of dynamic susceptibility magnetic resonance imaging at initial tumor diagnosis with the prognosis of differ
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ORIGINAL ARTICLE
Association of dynamic susceptibility magnetic resonance imaging at initial tumor diagnosis with the prognosis of different molecular glioma subtypes Cornelia Brendle 1 & Uwe Klose 1 & Johann-Martin Hempel 1 & Jens Schittenhelm 2 & Marco Skardelly 3 & Ghazaleh Tabatabai 4 & Ulrike Ernemann 1 & Benjamin Bender 1 Received: 31 January 2020 / Accepted: 15 May 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Purpose The updated 2016 CNS World Health Organization classification differentiates three main groups of diffuse glioma according to their molecular characteristics: astrocytic tumors with and without isocitrate dehydrogenase (IDH) mutation and 1p/ 19q co-deleted oligodendrogliomas. The present study aimed to determine whether dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) is an independent prognostic marker within the molecular subgroups of diffuse glioma. Methods Fifty-six patients with treatment-naive gliomas and advanced preoperative MRI examination were assessed retrospectively. The mean and maximal normalized cerebral blood volume values from DSC-MRI within the tumors were measured. Optimal cutoff values for the 1-year progression-free survival (PFS) were defined, and Kaplan-Meier analyses were performed separately for the three glioma subgroups. Results IDH wild-type astrocytic tumors had a higher mean and maximal perfusion than IDH-mutant astrocytic tumors and oligodendrogliomas. Patients with IDH wild-type astrocytic tumors and a low mean or maximal perfusion had a significantly shorter PFS than patients of the same group with high perfusion (p = 0.0159/0.0112). Furthermore, they had a significantly higher risk for early progression (hazard ratio = 5.6/5.1). This finding was independent of the methylation status of O6-methylguaninDNA-methyltransferase and variations of the therapy. Within the groups of IDH-mutant astrocytic tumors and oligodendrogliomas, the PFS of low and highly perfused tumors did not differ. Conclusion High perfusion upon initial diagnosis is not compellingly associated with worse short-term prognosis within the different molecular subgroups of diffuse glioma. Particularly, the overall highly perfused group of IDH wild-type astrocytic tumors contains tumors with low perfusion but unfavorable prognosis. Keywords Glioma . DSC-MRI . Perfusion . prognosis . IDH mutation . Molecular
Introduction
* Cornelia Brendle [email protected] 1
Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
2
Neuropathology, Department of Pathology and Neuropathology, Eberhard Karls University, Calwerstr. 3, 72076 Tuebingen, Germany
3
University Hospital for Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
4
Interdisciplinary Section of Neurooncology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
The 2016 update of the World Health Organization classification of brain tu
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