Raab Peter, Banan Rouzbeh, Akbarian Arash, Esmaeilzadeh Majid, Samii Madjid, Samii Amir, Bertalanffy Helmut, Lehmann Ulrich, Krauss Joachim K, Lanfermann Heinrich, Hartmann Christian, Brüning Roland
Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany.
Department of Neuropathology, University of Heidelberg, 69120 Heidelberg, Germany.
Cancers (Basel). 2022 Mar 9;14(6):1397. doi: 10.3390/cancers14061397.
We conducted a two-center retrospective survey on standard MRI features including apparent diffusion coefficient mapping (ADC) of diffuse midline gliomas H3 K27M-mutant (DMG) compared to midline glioblastomas H3 K27M-wildtype (midGBM-H3wt). We identified 39 intracranial DMG and 18 midGBM-H3wt tumors. Samples were microscopically re-evaluated for microvascular proliferations and necrosis. Image analysis focused on location, peritumoral edema, degree of contrast enhancement and DWI features. Within DMG, MRI features between tumors with or without histomorphological GBM features were compared. DMG occurred in 15/39 samples from the thalamus (38%), in 23/39 samples from the brainstem (59%) and in 1/39 tumors involving primarily the cerebellum (2%). Edema was present in 3/39 DMG cases (8%) versus 78% in the control (midGBM-H3wt) group (p < 0.001). Contrast enhancement at the tumor rim was detected in 17/39 DMG (44%) versus 67% in control (p = 0.155), and necrosis in 24/39 (62%) versus 89% in control (p = 0.060). Strong contrast enhancement was observed in 15/39 DMG (38%) versus 56% in control (p = 0.262). Apparent diffusion coefficient (ADC) histogram analysis showed significantly higher skewness and kurtosis values in the DMG group compared to the controls (p = 0.0016/p = 0.002). Minimum relative ADC (rADC) values, as well as the 10th and 25th rADC-percentiles, were lower in DMGs with GBM features within the DMG group (p < 0.001/p = 0.012/p = 0.027). In conclusion, DMG cases exhibited markedly less edema than midGBM-H3wt, even if histomorphological malignancy was present. Histologically malignant DMGs and midGBM-H3wt more often displayed strong enhancement, as well as rim enhancement, than DMGs without histomorphological malignancy. DMGs showed higher skewness and kurtosis values on ADC-histogram analysis compared to midGBM-H3wt. Lower minimum rADC values in DMGs indicated malignant histomorphological features, likely representing a more complex tissue microstructure.
我们进行了一项双中心回顾性研究，对比了弥漫性中线胶质瘤H3 K27M突变型（DMG）与中线胶质母细胞瘤H3 K27M野生型（midGBM - H3wt）的标准MRI特征，包括表观扩散系数图（ADC）。我们确定了39例颅内DMG肿瘤和18例midGBM - H3wt肿瘤。对样本进行显微镜下重新评估，以确定微血管增殖和坏死情况。图像分析聚焦于肿瘤位置、瘤周水肿、对比增强程度和DWI特征。在DMG组内，比较了具有或不具有组织形态学GBM特征的肿瘤之间的MRI特征。DMG发生于39例样本中的15例（38%）丘脑肿瘤、23例（59%）脑干肿瘤和1例（2%）主要累及小脑的肿瘤。39例DMG病例中有3例（8%）出现水肿，而对照组（midGBM - H3wt）为78%（p < 0.001）。39例DMG中有17例（44%）在肿瘤边缘检测到对比增强，而对照组为67%（p = 0.155）；39例中有24例（62%）出现坏死，对照组为89%（p = 0.060）。39例DMG中有15例（38%）观察到强烈对比增强，对照组为5(6%)（p = 0.262）。表观扩散系数（ADC）直方图分析显示，与对照组相比，DMG组的偏度和峰度值显著更高（p = 0.0016/p = 0.002）。在DMG组中，具有GBM特征的DMG的最小相对ADC（rADC）值以及第10和第25百分位rADC值较低（p < 0.001/p = 0.012/p = 0.027）。总之，即使存在组织形态学恶性特征，DMG病例的水肿也明显少于midGBM - H3wt。与无组织形态学恶性特征的DMG相比，组织学上恶性的DMG和midGBM - H3wt更常表现出强烈增强以及边缘增强。与midGBM - H3wt相比，DMG在ADC直方图分析中显示出更高的偏度和峰度值。DMG中较低的最小rADC值表明存在恶性组织形态学特征，可能代表更复杂的组织微观结构。
