Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma

Chen, I.E.; Swinburne, Nathaniel; Tsankova, Nadejda M.; Hefti, Marco M.; Aggarwal, Amit; Doshi, Amish; Hormigo, Adı́lia; Delman, Bradley N.; Nael, Kambiz

doi:10.3174/ajnr.a5639

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…PET-scan and diffusion MRI have previously been used to predict MP in LGG. In one study, the interval change of the 10th percentile ADC predicted progression on average 8 months before the RANO criteria in 12 of 13 patients with progressive LGG compared to 3 of 15 with stable disease [ 16 ]. In another study, MP appeared after 2 to 27 months after initial diagnosis in 78% of diffuse LGG with 18 F-FET-PET uptake shortly after the diagnosis compared to 0% with circumscribed LGG without uptake [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Perfusion imaging with arterial spin labeling (ASL)–MRI predicts malignant progression in low‑grade (WHO grade II) gliomas

et al. 2021

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Purpose Predicting malignant progression of grade II gliomas would allow for earlier initiation of treatment. The hypothesis for this single-centre, case–control study was that the perfusion signal on ASL-MRI predicts such malignant progression in the following 12 months. Methods Consecutive patients with the following criteria were included: ≥ 18 years, grade II glioma (biopsied or resected) and an ASL-MRI 6–12 months prior to malignant progression (cases) or stable disease (controls). Malignant progression was defined either radiologically (new T1w-contrast enhancement) or histologically (neurosurgical tissue sampling). Three controls were matched with each case. Some patients served as their own control by using earlier imaging. The ASL-MRIs were reviewed by two neuroradiologists and classified as positive (hyper-intense or iso-intense compared to cortical grey matter) or negative (hypo-intense). In patients with epilepsy, a neurologist reviewed clinicoradiological data to exclude peri-ictal pseudoprogression. The statistical analysis included diagnostic test properties, a Cohen’s Kappa interrater reliability coefficient and stratification for previous radiotherapy. Results Eleven cases (median age = 48, IQR = 43–50 years) and 33 controls (43, 27–50 years) were included. Malignant progression appeared at 37 months (median, IQR = 17–44) after first surgery. Thirty ASL-MRIs were assessed as negative and 14 as positive. None of the MRIs showed signs of peri-ictal pseudoprogression. ASL significantly predicted subsequent malignant progression (sensitivity = 73%; specificity = 82%; OR = 12; 95%-CI = 2.4–59.1; p = 0.002). The interrater reliability coefficient was 0.65. In stratified analysis, ASL-MRI predicted malignant progression both in patients with previous radiotherapy and in those without (Mantel–Haenszel test, p = 0.003). Conclusion Perfusion imaging with ASL-MRI can predict malignant progression within 12 months in patients with grade II glioma.

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Section: Discussionmentioning

confidence: 99%

Perfusion imaging with arterial spin labeling (ASL)–MRI predicts malignant progression in low‑grade (WHO grade II) gliomas

et al. 2021

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“…However, the diagnostic accuracy regarding PTZ was not scrutinized, possibly because of the scarce literature focusing on this specific subject. Interestingly, a study on tumor proliferation that focused exclusively on DLGG found that the interval changes of ADC values correctly predicted disease progression (diagnostic accuracy of 86%) before apparent radiologic progression on conventional imaging [43], supporting the potential use of radiomics in detecting peritumoral cells.…”

Section: Flair Mri Cannot Reflect the Ptz: How Can Dlgg Delineation B...mentioning

confidence: 95%

The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude

2022

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Diffuse low-grade gliomas (DLGGs) are heterogeneous and poorly circumscribed neoplasms with isolated tumor cells that extend beyond the margins of the lesion depicted on MRI. Efforts to demarcate the glioma core from the surrounding healthy brain led us to define an intermediate region, the so-called peritumoral zone (PTZ). Although most studies about PTZ have been conducted on high-grade gliomas, the purpose here is to review the cellular, metabolic, and radiological characteristics of PTZ in the specific context of DLGG. A better delineation of PTZ, in which glioma cells and neural tissue strongly interact, may open new therapeutic avenues to optimize both functional and oncological results. First, a connectome-based “supratotal” surgical resection (i.e., with the removal of PTZ in addition to the tumor core) resulted in prolonged survival by limiting the risk of malignant transformation, while improving the quality of life, thanks to a better control of seizures. Second, the timing and order of (neo)adjuvant medical treatments can be modulated according to the pattern of peritumoral infiltration. Third, the development of new drugs specifically targeting the PTZ could be considered from an oncological (such as immunotherapy) and epileptological perspective. Further multimodal investigations of PTZ are needed to maximize long-term outcomes in DLGG patients.

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“…Multiparametric evaluations have shown that a change in only 1 or 2 MRI features of a low-grade glioma, for example, focal low ADC, high relative cerebral blood volume, or a change in metabolic profile on proton magnetic resonance spectroscopy ( 1 H magnetic resonance spectroscopy), can suggest early high-grade transformation before any observable contrast enhancement on conventional MRI. 30,31 Such knowledge may be considerably beneficial for management of IDH-mutated tumors, because their distinct metabolism presents a feasible target for novel therapeutic agents. 32 Taking into consideration that glioblastomas only very rarely display a T2-FLAIR mismatch sign, we speculate that in some patients with mismatch-positive, residual or recurrent lower-grade gliomas, an early shift toward a grade IV lesion may be detected by observing a morphological and/or quantitative change in diffusivity from the initial mismatch pattern, possibly even preceding a discernible change on conventional T2W and FLAIR images.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, gliomas bearing a T2-FLAIR (or T2-DWI) mismatch sign revealed significantly higher mean ADC values, confirming an earlier finding by Foltyn et al 10 and suggesting that a separate range of ADC values may be required to form an adequate quantitative baseline for follow-up purposes in this tumor subset. Multiparametric evaluations have shown that a change in only 1 or 2 MRI features of a low-grade glioma, for example, focal low ADC, high relative cerebral blood volume, or a change in metabolic profile on proton magnetic resonance spectroscopy ( 1 H magnetic resonance spectroscopy), can suggest early high-grade transformation before any observable contrast enhancement on conventional MRI 30,31 . Such knowledge may be considerably beneficial for management of IDH -mutated tumors, because their distinct metabolism presents a feasible target for novel therapeutic agents 32 .…”

Section: Discussionmentioning

confidence: 99%

T2–Fluid-Attenuated Inversion Recovery Mismatch Sign in Grade II and III Gliomas: Is There a Coexisting T2–Diffusion-Weighted Imaging Mismatch?

Radović¹,

Špero²,

Pustahija³

et al. 2022

J Comput Assist Tomogr

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Objective: To determine whether the T2 fluid-attenuated inversion recovery (T2-FLAIR) mismatch sign in diffuse gliomas is associated with an equivalent pattern of disparity in signal intensities when comparing T2and diffusion-weighted imaging (DWI). Methods:The level of correspondence between T2-FLAIR and T2-DWI evaluations in 34 World Health Organization grade II/III gliomas and interreader agreement among 3 neuroradiologists were assessed by calculating intraclass correlation coefficient and κ statistics, respectively. Tumoral apparent diffusion coefficient values were compared using t test.Results: There was an almost perfect correspondence between the 2 mismatch signs (intraclass correlation coefficient = 0.824 [95% confidence interval, 0.68-0.91]) that were associated with higher mean tumoral apparent diffusion coefficient ( P < 0.01). Interreader agreement was substantial for T2-FLAIR (Fleiss κ = 0.724) and moderate for T2-DWI comparisons (Fleiss κ = 0.589) ( P < 0.001). Conclusions:The T2-FLAIR mismatch sign is usually reflected by a distinct microstructural pattern on DWI. The management of this tumor subtype may benefit from specifically tailored imaging assessments.

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Sequential Apparent Diffusion Coefficient for Assessment of Tumor Progression in Patients with Low-Grade Glioma

Cited by 7 publications

References 23 publications

Perfusion imaging with arterial spin labeling (ASL)–MRI predicts malignant progression in low‑grade (WHO grade II) gliomas

Perfusion imaging with arterial spin labeling (ASL)–MRI predicts malignant progression in low‑grade (WHO grade II) gliomas

The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude

T2–Fluid-Attenuated Inversion Recovery Mismatch Sign in Grade II and III Gliomas: Is There a Coexisting T2–Diffusion-Weighted Imaging Mismatch?

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