Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, National Hospital Organization, Higashihiroshima Medical Center, Hiroshima, Japan.
Department of Neuroscience, B&B Hospital, Gwarko, Lalitpur, Nepal.
Eur J Radiol. 2022 Feb;147:110103. doi: 10.1016/j.ejrad.2021.110103. Epub 2021 Dec 13.
Diffuse midline glioma (DMG), H3 K27M-mutant including diffuse intrinsic pontine glioma (DIPG) is a disease with dismal prognosis. We focused on diffusion-weighted imaging (DWI) and gadolinium enhanced T1WI (Gd), especially high intensity on DWI at non-enhanced lesion, i.e. DWI-Gd mismatch sign, to establish as an imaging biomarker of DMG patients.
Our institutional review board approved this retrospective study. Twenty-one patients diagnosed as DMG including DIPG at our institution between 2007 and 2020 were enrolled in this study. All patients underwent local radiotherapy of 54 Gy/30 fractions. We studied the relationship between imaging features including DWI-Gd mismatch sign and prognosis.
DWI-Gd mismatch sign was found in 9 out of 21 DMG patients. Among different imaging characteristics, existence of high intensity on DWI (P = 0.0014), gadolinium enhancement (P = 0.00071) were the significant poor prognostic markers in DMG, which were consistent with the previous reports about DIPG. In our results, positive DWI-Gd mismatch sign was statistically strongest poor prognostic imaging biomarker, and patients with positive DWI-Gd mismatch sign had shorter OS compared to those with negative mismatch sign (9.9 months vs 18.6 months, P = 0.00062). DWI/Gd mismatch sign and intratumoral bleeding were more common in DMG at thalamus compared to DMG at pons/DIPG (P = 0.046 and P = 0.0017, respectively).
DWI-Gd mismatch sign may be an imaging biomarker for poor prognosis in DMG. (E-1601).
弥漫性中线胶质瘤（DMG），H3 K27M 突变型，包括弥漫性内在脑桥胶质瘤（DIPG），是一种预后不良的疾病。我们专注于弥散加权成像（DWI）和钆增强 T1WI（Gd），特别是非增强病变上的高信号，即 DWI-Gd 不匹配征，将其确立为 DMG 患者的影像学生物标志物。
我们的机构审查委员会批准了这项回顾性研究。2007 年至 2020 年期间，在我院诊断为 DMG 包括 DIPG 的 21 例患者纳入本研究。所有患者均接受 54Gy/30 次局部放疗。我们研究了包括 DWI-Gd 不匹配征在内的影像学特征与预后的关系。
21 例 DMG 患者中，有 9 例存在 DWI-Gd 不匹配征。在不同的影像学特征中，DWI 上存在高信号（P=0.0014）、钆增强（P=0.00071）是 DMG 的显著不良预后标志物，与以前关于 DIPG 的报道一致。在我们的结果中，阳性 DWI-Gd 不匹配征是统计学上最强的不良预后影像学生物标志物，与阴性不匹配征相比，阳性 DWI-Gd 不匹配征患者的 OS 更短（9.9 个月 vs 18.6 个月，P=0.00062）。与桥脑/DIPG 的 DMG 相比，丘脑的 DMG 中更常见 DWI/Gd 不匹配征和瘤内出血（P=0.046 和 P=0.0017）。
DWI-Gd 不匹配征可能是 DMG 预后不良的影像学生物标志物。（E-1601）。
