Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China.
Department of Nuclear Medicine, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China.
Neurosurg Rev. 2023 Jun 26;46(1):151. doi: 10.1007/s10143-023-02068-3.
Pediatric diffuse intrinsic pontine glioma (DIPG) is a radiologically heterogeneous disease entity, here we aim to establish a multimodal imaging-based radiological classification and evaluate the outcome of different treatment strategies under this classification frame.
This retrospective study included 103 children diagnosed with DIPGs between January 2015 and August 2018 in Beijing Tiantan Hospital (Beijing, China). Multimodal radiological characteristics, including conventional magnetic resonance imaging (MRI), diffuse tensor imaging/diffuse tensor tractography (DTI/DTT), and positron emission tomography (PET) were reviewed to construct the classification. The outcome of different treatment strategies was compared in each DIPG subgroup using Kaplan-Meier method (log-rank test) to determine the optimal treatment for specific DIPGs.
Four radiological DIPG types were identified: Type A ("homocentric", n=13), Type B ("ventral", n=41), Type C ("eccentric", n=37), and Type D ("dorsal", n=12). Their treatment modalities were grouped as observation (43.7%), cytoreductive surgery (CRS) plus radiotherapy (RT) (24.3%), RT alone (11.7%), and CRS alone (20.4%). CRS+RT mainly fell into type C (29.7%), followed by type B1 (21.9%) and type D (50%). Overall, CRS+RT exhibited a potential survival advantage compared to RT alone, which was more pronounced in specific type, but this did not reach statistical significance, due to limited sample size and unbalanced distribution.
We proposed a multimodality imaging-based radiological classification for pediatric DIPG, which was useful for selecting optimal treatment strategies, especially for identifying candidates who may benefit from CRS plus RT. This classification opened a window into image-guided integrated treatment for pediatric DIPG.
小儿弥漫性内在脑桥胶质瘤（DIPG）是一种影像学异质性疾病实体，本研究旨在建立一种基于多模态影像学的放射学分类，并在此分类框架下评估不同治疗策略的结果。
本回顾性研究纳入了 2015 年 1 月至 2018 年 8 月期间在北京天坛医院（中国北京）诊断为 DIPG 的 103 名儿童。对常规磁共振成像（MRI）、弥散张量成像/弥散张量纤维束成像（DTI/DTT）和正电子发射断层扫描（PET）等多模态影像学特征进行回顾性分析，构建分类。采用 Kaplan-Meier 法（对数秩检验）比较不同治疗策略在每个 DIPG 亚组中的结果，以确定特定 DIPG 的最佳治疗方法。
确定了四种放射学 DIPG 类型：A型（“同心性”，n=13）、B 型（“腹侧”，n=41）、C 型（“偏心性”，n=37）和 D 型（“背侧”，n=12）。他们的治疗方式分为观察组（43.7%）、细胞减灭术（CRS）+放疗（RT）组（24.3%）、单纯 RT 组（11.7%）和单纯 CRS 组（20.4%）。CRS+RT 主要集中在 C 型（29.7%），其次是 B1 型（21.9%）和 D 型（50%）。总体而言，CRS+RT 与单纯 RT 相比具有潜在的生存优势，在特定类型中更为明显，但由于样本量有限且分布不均，这并未达到统计学意义。
我们提出了一种基于多模态影像学的小儿 DIPG 放射学分类，有助于选择最佳治疗策略，特别是识别可能从 CRS+RT 中获益的患者。该分类为小儿 DIPG 的图像引导综合治疗开辟了一扇窗。
