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Ryba A, Özdemir Z, Nissimov N, Hönikl L, Neidert N, Jakobs M, Kalasauskas D, Krigers A, Thomé C, Freyschlag C, Ringel F, Unterberg A, Dao Trong P, Beck J, Heiland D, Meyer B, Vajkoczy P, Onken J, Stummer W, Suero Molina E, Gempt J, Westphal M, Schüller U, Mohme M. Insights from a multicenter study on adult H3 K27M-mutated glioma: Surgical resection's limited influence on overall survival, ATRX as molecular prognosticator. Neuro Oncol 2024; 26:1479-1493. [PMID: 38507506 PMCID: PMC11300017 DOI: 10.1093/neuonc/noae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND H3 K27M-mutated gliomas were first described as a new grade 4 entity in the 2016 World Health Organization classification. Current studies have focused on its typical appearance in children and young adults, increasing the need to better understand the prognostic factors and impact of surgery on adults. Here, we report a multicentric study of this entity in adults. METHODS We included molecularly confirmed H3 K27M-mutated glioma cases in patients ≥ 18 years diagnosed between 2016 and 2022. Clinical, radiological, and surgical features were analyzed. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS Among 70 patients with a mean age of 36.1 years, the median overall survival (OS) was 13.6 ± 14 months. Gross-total resection was achieved in 14.3% of patients, whereas 30% had a subtotal resection and 54.3% a biopsy. Tumors located in telencephalon/diencephalon/myelencephalon were associated with a poorer OS, while a location in the mesencephalon/metencephalon showed a significantly longer OS (8.7 vs. 25.0 months, P = .007). Preoperative Karnofsky-Performance Score (KPS) ≤ 80 showed a reduced OS (4.2 vs. 18 months, P = .02). Furthermore, ATRX loss, found in 25.7%, was independently associated with an increased OS (31 vs. 8.3 months, P = .0029). Notably, patients undergoing resection showed no survival benefit over biopsy (12 vs. 11 months, P = .4006). CONCLUSIONS The present study describes surgical features of H3 K27M-mutated glioma in adulthood in a large multicentric study. Our data reveal that ATRX status, location and KPS significantly impact OS in H3 K27M-mutated glioma. Importantly, our dataset indicates that resection does not offer a survival advantage over biopsy.
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Affiliation(s)
- Alice Ryba
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zeynep Özdemir
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Nitzan Nissimov
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Lisa Hönikl
- Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Nicolas Neidert
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Martin Jakobs
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Division of Stereotactic Neurosurgery, Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Darius Kalasauskas
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Aleksandrs Krigers
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Jens Gempt
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schüller
- Institute of Neuropathology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center Hamburg, Hamburg, Germany
| | - Malte Mohme
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Blasco-Santana L, Colmenero I. Molecular and Pathological Features of Paediatric High-Grade Gliomas. Int J Mol Sci 2024; 25:8498. [PMID: 39126064 PMCID: PMC11312892 DOI: 10.3390/ijms25158498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Paediatric high-grade gliomas are among the most common malignancies found in children. Despite morphological similarities to their adult counterparts, there are profound biological and molecular differences. Furthermore, and thanks to molecular biology, the diagnostic pathology of paediatric high-grade gliomas has experimented a dramatic shift towards molecular classification, with important prognostic implications, as is appropriately reflected in both the current WHO Classification of Tumours of the Central Nervous System and the WHO Classification of Paediatric Tumours. Emphasis is placed on histone 3, IDH1, and IDH2 alterations, and on Receptor of Tyrosine Kinase fusions. In this review we present the current diagnostic categories from the diagnostic pathology perspective including molecular features.
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Affiliation(s)
- Luis Blasco-Santana
- Pathology Department, Hospital Infantil Universitario del Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009 Madrid, Spain
| | - Isabel Colmenero
- Pathology Department, Hospital Infantil Universitario del Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009 Madrid, Spain
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3
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Hayashi N, Fukai J, Nakatogawa H, Kawaji H, Yoshioka E, Kodama Y, Nakajo K, Uda T, Naito K, Kijima N, Okita Y, Kagawa N, Takahashi Y, Hashimoto N, Arita H, Takano K, Sakamoto D, Iida T, Arakawa Y, Kawauchi T, Sonoda Y, Mitobe Y, Ishibashi K, Matsuda M, Achiha T, Tomita T, Nonaka M, Hara K, Takebe N, Tsuzuki T, Nakajima Y, Ohue S, Nakajima N, Watanabe A, Inoue A, Umegaki M, Kanematsu D, Katsuma A, Sumida M, Shofuda T, Mano M, Kinoshita M, Mori K, Nakao N, Kanemura Y. Neuroradiological, genetic and clinical characteristics of histone H3 K27-mutant diffuse midline gliomas in the Kansai Molecular Diagnosis Network for CNS Tumors (Kansai Network): multicenter retrospective cohort. Acta Neuropathol Commun 2024; 12:120. [PMID: 39061104 PMCID: PMC11282756 DOI: 10.1186/s40478-024-01808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/27/2024] [Indexed: 07/28/2024] Open
Abstract
This study aims to elucidate the clinical and molecular characteristics, treatment outcomes and prognostic factors of patients with histone H3 K27-mutant diffuse midline glioma. We retrospectively analyzed 93 patients with diffuse midline glioma (47 thalamus, 24 brainstem, 12 spinal cord and 10 other midline locations) treated at 24 affiliated hospitals in the Kansai Molecular Diagnosis Network for CNS Tumors. Considering the term "midline" areas, which had been confused in previous reports, we classified four midline locations based on previous reports and anatomical findings. Clinical and molecular characteristics of the study cohort included: age 4-78 years, female sex (41%), lower-grade histology (56%), preoperative Karnofsky performance status (KPS) scores ≥ 80 (49%), resection (36%), adjuvant radiation plus chemotherapy (83%), temozolomide therapy (76%), bevacizumab therapy (42%), HIST1H3B p.K27M mutation (2%), TERT promoter mutation (3%), MGMT promoter methylation (9%), BRAF p.V600E mutation (1%), FGFR1 mutation (14%) and EGFR mutation (3%). Median progression-free and overall survival time was 9.9 ± 1.0 (7.9-11.9, 95% CI) and 16.6 ± 1.4 (13.9-19.3, 95% CI) months, respectively. Female sex, preoperative KPS score ≥ 80, adjuvant radiation + temozolomide and radiation ≥ 50 Gy were associated with favorable prognosis. Female sex and preoperative KPS score ≥ 80 were identified as independent good prognostic factors. This study demonstrated the current state of clinical practice for patients with diffuse midline glioma and molecular analyses of diffuse midline glioma in real-world settings. Further investigation in a larger population would contribute to better understanding of the pathology of diffuse midline glioma.
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Affiliation(s)
- Nobuhide Hayashi
- Department of Neurosurgery, Wakayama Rosai Hospital, Kinomoto 93-1, Wakayama City, Wakayama, 640-8505, Japan.
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan.
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan.
| | - Junya Fukai
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan.
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan.
| | - Hirokazu Nakatogawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Pediatric Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hiroshi Kawaji
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Ema Yoshioka
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Yoshinori Kodama
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Kosuke Nakajo
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Takehiro Uda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Kentaro Naito
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Noriyuki Kijima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yoshiko Okita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Naoki Kagawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yoshinobu Takahashi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, School of Medical Science, Kyoto Prefectural University Graduate, Kyoto City, Kyoto, 602-8566, Japan
| | - Naoya Hashimoto
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, School of Medical Science, Kyoto Prefectural University Graduate, Kyoto City, Kyoto, 602-8566, Japan
| | - Hideyuki Arita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Koji Takano
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Daisuke Sakamoto
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomoko Iida
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshiki Arakawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto, 606-8507, Japan
| | - Takeshi Kawauchi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Red Cross Hospital, Osaka City, Osaka, 543-8555, Japan
| | - Yukihiko Sonoda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata City, Yamagata, 990-8560, Japan
| | - Yuta Mitobe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata City, Yamagata, 990-8560, Japan
| | - Kenichi Ishibashi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka City General Hospital, Osaka City, Osaka, 534-0021, Japan
| | - Masahide Matsuda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takamune Achiha
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, 660-8511, Japan
| | - Takahiro Tomita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama City, Toyama, 930-0194, Japan
| | - Masahiro Nonaka
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, 573-1191, Japan
| | - Keijiro Hara
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8501, Japan
| | - Noriyoshi Takebe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Medical Research Institute, Tazuke Kofukai Foundation, Kitano Hospital, Osaka City, Osaka, 530-8480, Japan
| | - Takashi Tsuzuki
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Sakai City Medical Center, Sakai, Osaka, 593-8304, Japan
| | - Yoshikazu Nakajima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Sakai City Medical Center, Sakai, Osaka, 593-8304, Japan
- Department of Neurosurgery, Kobe Tokushukai Hospital, Kobe, Hyogo, 655-0017, Japan
| | - Shiro Ohue
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama, Ehime, 790-0024, Japan
| | - Nobuyuki Nakajima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Tokyo Medical University, Tokyo, 160-0023, Japan
| | - Akira Watanabe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, 630-0293, Japan
| | - Akihiro Inoue
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Masao Umegaki
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, 564-8567, Japan
| | - Daisuke Kanematsu
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Asako Katsuma
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Miho Sumida
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Tomoko Shofuda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Stem Cell Research, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Masayuki Mano
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Central Laboratory and Surgical Pathology, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Manabu Kinoshita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kanji Mori
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Yao Municipal Hospital, Yao, Osaka, 581-0069, Japan
| | - Naoyuki Nakao
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan
| | - Yonehiro Kanemura
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
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Desai J, Rajkumar S, Shepard MJ, Herbst J, Karlovits SM, Hasan S, Horne ZD, Wegner RE. National trends in the treatment of adult diffuse midline gliomas: a rare clinical scenario. J Neurooncol 2024; 168:269-274. [PMID: 38630388 DOI: 10.1007/s11060-024-04663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/26/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE Diffuse midline gliomas (DMG) include all midline gliomas with a point mutation to the histone H3 gene resulting in the substitution of a lysine with a methionine (K27M). These tumors are classified as World Health Organization grade 4 with a mean survival between 9- and 19-months following diagnosis. There is currently no standard of care for DMG, and palliative radiation therapy has been proven to only extend survival by months. Our current study aims to report current treatment trends and predictors of the overall survival of DMG. METHODS We searched the National Cancer Database for adult patients treated for DMG from 2016 to 2020. Patients were required to have been treated with primary radiation directed at the brain with or without concurrent chemotherapy. Univariable and multivariable Cox regressions were used to determine predictors of overall survival. RESULTS Of the 131 patients meeting the inclusion criteria, 113 (86%) received radiation and chemotherapy. Based on multivariable Cox regression, significant predictors of survival were Charlson-Deyo comorbidity index and race. Patients with a Charlson-Deyo score of 1 had 2.72 times higher odds of mortality than those with a score of 0. Patients not identifying as White or Black had 2.67 times higher odds of mortality than those identifying as White. The median survival for all patients was 19 months. CONCLUSIONS Despite being considered ineffective, chemotherapy is still administered in most adult patients diagnosed with DMG. Significant predictors of survival were Charlson-Deyo comorbidity index and race.
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Affiliation(s)
- Jay Desai
- Drexel University College of Medicine, Philadelphia, USA
| | - Sujay Rajkumar
- Drexel University College of Medicine, Philadelphia, USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, USA
| | - John Herbst
- Division of Medical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA
| | - Stephen M Karlovits
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA
| | | | - Zachary D Horne
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA.
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Jiang J, Li WB, Xiao SW. Prognostic factors analysis of diffuse midline glioma. J Neurooncol 2024; 167:285-292. [PMID: 38381257 PMCID: PMC11023999 DOI: 10.1007/s11060-024-04605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE This study retrospectively analyzes cases of diffuse midline glioma treated with radiotherapy, with the aim of investigating the prognosis of the tumor and its influencing factors. METHODS From January 2018 to November 2022, we treated 64 patients who were pathologically diagnosed with diffuse midline glioma. Among them, 41 underwent surgical resection, and 23 underwent biopsy procedures. All patients received postoperative radiotherapy. We followed up with the patients to determine the overall survival rate and conducted univariate and multivariate analyses on relevant indicators. RESULTS The median survival time for the entire patient group was 33.3 months, with overall survival rates of 92.9%, 75.4%, and 45.0% at 1 year, 2 years, and 3 years, respectively. Univariate and multivariate analyses indicated that older patients had a better prognosis. CONCLUSION Patient age is an independent prognostic factor for patients with diffuse midline glioma undergoing radiation therapy.
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Affiliation(s)
- Jing Jiang
- Department of Neuro-oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100071, China
- Department of Radiation Oncology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Wen-Bin Li
- Department of Neuro-oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100071, China.
| | - Shao-Wen Xiao
- Department of Radiation Oncology, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China.
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Zhang S, Yang X, Tan Q, Sun H, Chen D, Chen Y, Zhang H, Yang Y, Gong Q, Yue Q. Cortical myelin and thickness mapping provide insights into whole-brain tumor burden in diffuse midline glioma. Cereb Cortex 2024; 34:bhad491. [PMID: 38112602 PMCID: PMC10793579 DOI: 10.1093/cercor/bhad491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
Systemic infiltration is a hallmark of diffuse midline glioma pathogenesis, which can trigger distant disturbances in cortical structure. However, the existence and effects of these changes have been underexamined. This study aimed to investigate whole-brain cortical myelin and thickness alternations induced by diffuse midline glioma. High-resolution T1- and T2-weighted images were acquired from 90 patients with diffuse midline glioma with H3 K27-altered and 64 patients with wild-type and 86 healthy controls. Cortical thickness and myelin content was calculated using Human Connectome Project pipeline. Significant differences in cortical thickness and myelin content were detected among groups. Short-term survival prediction model was constructed using automated machine learning. Compared with healthy controls, diffuse midline glioma with H3 K27-altered patients showed significantly reduced cortical myelin in bilateral precentral gyrus, postcentral gyrus, insular, parahippocampal gyrus, fusiform gyrus, and cingulate gyrus, whereas diffuse midline glioma with H3 K27 wild-type patients exhibited well-preserved myelin content. Furtherly, when comparing diffuse midline glioma with H3 K27-altered and diffuse midline glioma with H3 K27 wild-type, the decreased cortical thickness in parietal and occipital regions along with demyelination in medial orbitofrontal cortex was observed in diffuse midline glioma with H3 K27-altered. Notably, a combination of cortical features and tumor radiomics allowed short-term survival prediction with accuracy 0.80 and AUC 0.84. These findings may aid clinicians in tailoring therapeutic approaches based on cortical characteristics, potentially enhancing the efficacy of current and future treatment modalities.
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Affiliation(s)
- Simin Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610072, China
| | - Xibiao Yang
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu 610041, China
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Qiaoyue Tan
- Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610072, China
| | - Di Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610072, China
| | - Yinying Chen
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Hongjing Zhang
- Huaxi Glioma Center, West China Hospital of Sichuan University, Chengdu 610041, China
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610065, China
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen 610041, China
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Huaxi Glioma Center, West China Hospital of Sichuan University, Chengdu 610041, China
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7
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Cheng D, Zhuo Z, Zhang P, Qu L, Duan Y, Xu X, Xie C, Liu X, Haller S, Barkhof F, Zhang L, Liu Y. Amide proton transfer-weighted imaging of pediatric brainstem glioma and its predicted value for H3 K27 alteration. Acta Radiol 2023; 64:2922-2930. [PMID: 37722801 DOI: 10.1177/02841851231197503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Non-invasive determination of H3 K27 alteration of pediatric brainstem glioma (pedBSG) remains a clinical challenge. PURPOSE To predict H3 K27-altered pedBSG using amide proton transfer-weighted (APTw) imaging. MATERIAL AND METHODS This retrospective study included patients with pedBSG who underwent APTw imaging and had the H3 K27 alteration status determined by immunohistochemical staining. The presence or absence of foci of markedly increased APTw signal in the lesion was visually assessed. Quantitative APTw histogram parameters within the entire solid portion of tumors were extracted and compared between H3 K27-altered and wild-type groups using Student's t-test. The ability of APTw for differential diagnosis was evaluated using logistic regression. RESULTS Sixty pedBSG patients included 48 patients with H3 K27-altered tumor (aged 2-48 years) and 12 patients with wild-type tumor (aged 3-53 years). Visual assessment showed that the foci of markedly increased APTw signal intensity were more common in the H3 K27-altered group than in wild-type group (60% vs. 16%, P = 0.007). Histogram parameters of APTw signal intensity in the H3 K27-altered group were significantly higher than those in the wild-type group (median, 2.74% vs. 2.22%, P = 0.02). The maximum (area under the receiver operating characteristic curve [AUC] = 0.72, P = 0.01) showed the highest diagnostic performance among histogram analysis. A combination of age, median and maximum APTw signal intensity could predict H3 K27 alteration with a sensitivity of 81%, specificity of 75% and AUC of 0.80. CONCLUSION APTw imaging may serve as an imaging biomarker for H3 K27 alteration of pedBSGs.
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Affiliation(s)
- Dan Cheng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liying Qu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaolu Xu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cong Xie
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing Liu
- Beijing Neurosurgical Institute, Beijing, China
| | - Sven Haller
- Department of Imaging and Medical Informatics, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
| | - Frederik Barkhof
- UCL Institutes of Neurology and Healthcare Engineering, London, UK
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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8
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Hirschler L, Sollmann N, Schmitz‐Abecassis B, Pinto J, Arzanforoosh F, Barkhof F, Booth T, Calvo‐Imirizaldu M, Cassia G, Chmelik M, Clement P, Ercan E, Fernández‐Seara MA, Furtner J, Fuster‐Garcia E, Grech‐Sollars M, Guven NT, Hatay GH, Karami G, Keil VC, Kim M, Koekkoek JAF, Kukran S, Mancini L, Nechifor RE, Özcan A, Ozturk‐Isik E, Piskin S, Schmainda K, Svensson SF, Tseng C, Unnikrishnan S, Vos F, Warnert E, Zhao MY, Jancalek R, Nunes T, Emblem KE, Smits M, Petr J, Hangel G. Advanced MR Techniques for Preoperative Glioma Characterization: Part 1. J Magn Reson Imaging 2023; 57:1655-1675. [PMID: 36866773 PMCID: PMC10946498 DOI: 10.1002/jmri.28662] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/04/2023] Open
Abstract
Preoperative clinical magnetic resonance imaging (MRI) protocols for gliomas, brain tumors with dismal outcomes due to their infiltrative properties, still rely on conventional structural MRI, which does not deliver information on tumor genotype and is limited in the delineation of diffuse gliomas. The GliMR COST action wants to raise awareness about the state of the art of advanced MRI techniques in gliomas and their possible clinical translation or lack thereof. This review describes current methods, limits, and applications of advanced MRI for the preoperative assessment of glioma, summarizing the level of clinical validation of different techniques. In this first part, we discuss dynamic susceptibility contrast and dynamic contrast-enhanced MRI, arterial spin labeling, diffusion-weighted MRI, vessel imaging, and magnetic resonance fingerprinting. The second part of this review addresses magnetic resonance spectroscopy, chemical exchange saturation transfer, susceptibility-weighted imaging, MRI-PET, MR elastography, and MR-based radiomics applications. Evidence Level: 3 Technical Efficacy: Stage 2.
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Affiliation(s)
- Lydiane Hirschler
- C.J. Gorter MRI Center, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Nico Sollmann
- Department of Diagnostic and Interventional RadiologyUniversity Hospital UlmUlmGermany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
- TUM‐Neuroimaging Center, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Bárbara Schmitz‐Abecassis
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Medical Delta FoundationDelftThe Netherlands
| | - Joana Pinto
- Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
| | | | - Frederik Barkhof
- Department of Radiology & Nuclear MedicineAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image ComputingUniversity College LondonLondonUK
| | - Thomas Booth
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of NeuroradiologyKing's College Hospital NHS Foundation TrustLondonUK
| | | | | | - Marek Chmelik
- Department of Technical Disciplines in Medicine, Faculty of Health CareUniversity of PrešovPrešovSlovakia
| | - Patricia Clement
- Department of Diagnostic SciencesGhent UniversityGhentBelgium
- Department of Medical ImagingGhent University HospitalGhentBelgium
| | - Ece Ercan
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Maria A. Fernández‐Seara
- Department of RadiologyClínica Universidad de NavarraPamplonaSpain
- IdiSNA, Instituto de Investigación Sanitaria de NavarraPamplonaSpain
| | - Julia Furtner
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Research Center of Medical Image Analysis and Artificial IntelligenceDanube Private UniversityKrems an der DonauAustria
| | - Elies Fuster‐Garcia
- Biomedical Data Science Laboratory, Instituto Universitario de Tecnologías de la Información y ComunicacionesUniversitat Politècnica de ValènciaValenciaSpain
| | - Matthew Grech‐Sollars
- Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Nazmiye Tugay Guven
- Institute of Biomedical EngineeringBogazici University IstanbulIstanbulTurkey
| | - Gokce Hale Hatay
- Institute of Biomedical EngineeringBogazici University IstanbulIstanbulTurkey
| | - Golestan Karami
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Vera C. Keil
- Department of Radiology & Nuclear MedicineAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Mina Kim
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering and Department of NeuroinflammationUniversity College LondonLondonUK
| | - Johan A. F. Koekkoek
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyHaaglanden Medical CenterThe HagueThe Netherlands
| | - Simran Kukran
- Department of BioengineeringImperial College LondonLondonUK
- Department of Radiotherapy and ImagingInstitute of Cancer ResearchLondonUK
| | - Laura Mancini
- Lysholm Department of Neuroradiology, National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
- Department of Brain Repair and Rehabilitation, Institute of NeurologyUniversity College LondonLondonUK
| | - Ruben Emanuel Nechifor
- Department of Clinical Psychology and PsychotherapyInternational Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes‐Bolyai UniversityCluj‐NapocaRomania
| | - Alpay Özcan
- Electrical and Electronics Engineering DepartmentBogazici University IstanbulIstanbulTurkey
| | - Esin Ozturk‐Isik
- Institute of Biomedical EngineeringBogazici University IstanbulIstanbulTurkey
| | - Senol Piskin
- Department of Mechanical Engineering, Faculty of Natural Sciences and EngineeringIstinye University IstanbulIstanbulTurkey
| | - Kathleen Schmainda
- Department of BiophysicsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Siri F. Svensson
- Department of Physics and Computational RadiologyOslo University HospitalOsloNorway
- Department of PhysicsUniversity of OsloOsloNorway
| | - Chih‐Hsien Tseng
- Medical Delta FoundationDelftThe Netherlands
- Department of Imaging PhysicsDelft University of TechnologyDelftThe Netherlands
| | - Saritha Unnikrishnan
- Faculty of Engineering and DesignAtlantic Technological University (ATU) SligoSligoIreland
- Mathematical Modelling and Intelligent Systems for Health and Environment (MISHE), ATU SligoSligoIreland
| | - Frans Vos
- Medical Delta FoundationDelftThe Netherlands
- Department of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands
- Department of Imaging PhysicsDelft University of TechnologyDelftThe Netherlands
| | - Esther Warnert
- Department of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands
| | - Moss Y. Zhao
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | - Radim Jancalek
- Department of NeurosurgerySt. Anne's University Hospital, BrnoBrnoCzech Republic
- Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
| | - Teresa Nunes
- Department of NeuroradiologyHospital Garcia de OrtaAlmadaPortugal
| | - Kyrre E. Emblem
- Department of Physics and Computational RadiologyOslo University HospitalOsloNorway
| | - Marion Smits
- Institute of Biomedical Engineering, Department of Engineering ScienceUniversity of OxfordOxfordUK
- Department of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands
- Brain Tumour CentreErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Jan Petr
- Helmholtz‐Zentrum Dresden‐RossendorfInstitute of Radiopharmaceutical Cancer ResearchDresdenGermany
| | - Gilbert Hangel
- Department of NeurosurgeryMedical University of ViennaViennaAustria
- High Field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for MR Imaging BiomarkersViennaAustria
- Medical Imaging ClusterMedical University of ViennaViennaAustria
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9
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Lovibond S, Gewirtz AN, Pasquini L, Krebs S, Graham MS. The promise of metabolic imaging in diffuse midline glioma. Neoplasia 2023; 39:100896. [PMID: 36944297 PMCID: PMC10036941 DOI: 10.1016/j.neo.2023.100896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
Recent insights into histopathological and molecular subgroups of glioma have revolutionized the field of neuro-oncology by refining diagnostic categories. An emblematic example in pediatric neuro-oncology is the newly defined diffuse midline glioma (DMG), H3 K27-altered. DMG represents a rare tumor with a dismal prognosis. The diagnosis of DMG is largely based on clinical presentation and characteristic features on conventional magnetic resonance imaging (MRI), with biopsy limited by its delicate neuroanatomic location. Standard MRI remains limited in its ability to characterize tumor biology. Advanced MRI and positron emission tomography (PET) imaging offer additional value as they enable non-invasive evaluation of molecular and metabolic features of brain tumors. These techniques have been widely used for tumor detection, metabolic characterization and treatment response monitoring of brain tumors. However, their role in the realm of pediatric DMG is nascent. By summarizing DMG metabolic pathways in conjunction with their imaging surrogates, we aim to elucidate the untapped potential of such imaging techniques in this devastating disease.
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Affiliation(s)
- Samantha Lovibond
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandra N Gewirtz
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luca Pasquini
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Simone Krebs
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Radiochemistry and Imaging Sciences Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Maya S Graham
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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10
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Isfaoun Z, Laasri K, Jidal M, Cherradi N, Melhaoui A, Chat L, Haddad SE, Kababri ME, Khorassani ME, Kili A, Ansari NE, Hessissen L. A rare presentation of a spinal diffuse midline glioma in a child: a case report. Pan Afr Med J 2023; 44:183. [PMID: 37484594 PMCID: PMC10362656 DOI: 10.11604/pamj.2023.44.183.39885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 07/25/2023] Open
Abstract
Our patient had an extremely rare type of pediatric Diffuse Midline Glioma (DMG) with modified H3 K27 that occurred in the cervical spinal cord. Due to its location in the spinal cord, slow clinical presentation with torticollis for 7 months, and the non-specific radiological appearance of this tumour, it was initially considered to be a low-grade glioma. Based on imaging findings, the neurosurgery team performed a complete surgical resection, but the pathological features were consistent with a high-grade, diffuse midline glioma. Therefore, we are reporting a case of an altered high-grade DMG H3K27 glioma, which is difficult to diagnose due to its slow clinical symptoms which caused a delay in diagnosis, non-specific imaging, and with difficulty in accessing histopathological markers in low and middle income countries (LMIC).
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Affiliation(s)
- Zineb Isfaoun
- Mohammed V University, Pediatric Hematology and Oncology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Khadija Laasri
- Mohammed V University, Radiology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Manal Jidal
- Mohammed V University, Radiology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Nadia Cherradi
- Mohammed V University, Pathology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Adil Melhaoui
- Mohammed V University, Neurosurgery Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Latifa Chat
- Mohammed V University, Radiology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Siham El Haddad
- Mohammed V University, Radiology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Maria El Kababri
- Mohammed V University, Pediatric Hematology and Oncology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Mohamed El Khorassani
- Mohammed V University, Pediatric Hematology and Oncology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Amina Kili
- Mohammed V University, Pediatric Hematology and Oncology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Naoual El Ansari
- Mohammed V University, Pediatric Hematology and Oncology Department, Children’s Hospital in Rabat, Rabat, Morocco
| | - Laila Hessissen
- Mohammed V University, Pediatric Hematology and Oncology Department, Children’s Hospital in Rabat, Rabat, Morocco
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11
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Fiz F, Bottoni G, Ugolini M, Righi S, Cirone A, Garganese MC, Verrico A, Rossi A, Milanaccio C, Ramaglia A, Mastronuzzi A, Abate ME, Cacchione A, Gandolfo C, Colafati GS, Garrè ML, Morana G, Piccardo A. Diagnostic and Dosimetry Features of [ 64Cu]CuCl 2 in High-Grade Paediatric Infiltrative Gliomas. Mol Imaging Biol 2023; 25:391-400. [PMID: 36042116 DOI: 10.1007/s11307-022-01769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 03/12/2023]
Abstract
PURPOSE OF THE REPORT Paediatric diffuse high-grade gliomas (PDHGG) are rare central nervous system neoplasms lacking effective therapeutic options. Molecular imaging of tumour metabolism might identify novel diagnostic/therapeutic targets. In this study, we evaluated the distribution and the dosimetry aspects of [64Cu]CuCl2 in PDHGG subjects, as copper is a key element in cellular metabolism whose turnover may be increased in tumour cells. MATERIAL AND METHODS Paediatric patients with PDHGG were prospectively recruited. [64Cu]CuCl2 PET/CT was performed 1 h after tracer injection; if the scan was positive, it was repeated 24 and 72 h later. Lesion standardised uptake value (SUV) and target-to-background ratio (TBR) were calculated. Tumour and organ dosimetry were computed using the MIRD algorithm. Each patient underwent an MRI scan, including FLAIR, T2-weighted and post-contrast T1-weighted imaging. RESULTS Ten patients were enrolled (median age 9, range 6-16 years, 6 females). Diagnoses were diffuse midline gliomas (n = 8, 5 of which with H3K27 alterations) and diffuse hemispheric gliomas (n = 2). Six patients had visible tracer uptake (SUV: 1.0 ± 0.6 TBR: 5 ± 3.1). [64Cu]CuCl2 accumulation was always concordant with MRI contrast enhancement and was higher in the presence of radiological signs of necrosis. SUV and TBR progressively increased on the 24- and 72-h acquisitions (p < 0.05 and p < 0.01, respectively). The liver and the abdominal organs received the highest non-target dose. CONCLUSIONS [64Cu]CuCl2 is a well-tolerated radiotracer with reasonably favourable dosimetric properties, showing selective uptake in tumour areas with visible contrast enhancement and necrosis, thus suggesting that blood-brain barrier damage is a pre-requisite for its distribution to the intracranial structures. Moreover, tracer uptake showed an accumulating trend over time. These characteristics could deserve further analysis, to determine whether this radiopharmaceutical might have a possible therapeutic role as well.
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Affiliation(s)
- Francesco Fiz
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy.
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Martina Ugolini
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Sergio Righi
- Medical Physics Department, E.O. Galliera Hospital, Genoa, Italy
| | - Alessio Cirone
- Medical Physics Department, E.O. Galliera Hospital, Genoa, Italy
| | - Maria Carmen Garganese
- Nuclear Medicine Unit/Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Verrico
- Neuro-Oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Antonia Ramaglia
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angela Mastronuzzi
- Neuro-Oncology Unit, Department of Paediatric Haematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | | | - Antonella Cacchione
- Neuro-Oncology Unit, Department of Paediatric Haematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Carlo Gandolfo
- Imaging Department, Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy
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12
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Jordan JT, Gerstner ER. Imaging of Brain Tumors. Continuum (Minneap Minn) 2023; 29:171-193. [PMID: 36795877 DOI: 10.1212/con.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article focuses on neuroimaging as an essential tool for diagnosing brain tumors and monitoring response to treatment. LATEST DEVELOPMENTS Neuroimaging is useful at all stages of brain tumor care. Technologic advances have improved the clinical diagnostic capability of neuroimaging as a vital complement to history, examination, and pathologic assessment. Presurgical evaluations are enriched by novel imaging techniques, through improved differential diagnosis and better surgical planning using functional MRI (fMRI) and diffusion tensor imaging. The common clinical challenge of differentiating tumor progression from treatment-related inflammatory change is aided by novel uses of perfusion imaging, susceptibility-weighted imaging (SWI), spectroscopy, and new positron emission tomography (PET) tracers. ESSENTIAL POINTS Using the most up-to-date imaging techniques will facilitate high-quality clinical practice in the care of patients with brain tumors.
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13
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Di Nunno V, Franceschi E, Gatto L, Tosoni A, Bartolini S, Brandes AA. How to treat histone 3 altered gliomas: molecular landscape and therapeutic developments. Expert Rev Clin Pharmacol 2023; 16:17-26. [PMID: 36576307 DOI: 10.1080/17512433.2023.2163385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Diffuse midline gliomas (DMG) and diffuse hemispheric glioma (DHG) are both rare tumors characterized and recognized for specific alterations of histone 3 including H3K27 (DMG) and H3G34 (DHG). Despite these tumors arising from alterations of the same gene their clinical, radiological, and molecular behaviors strongly diverge, requiring a personalized therapeutic approach. AREAS COVERED We performed a review on Medline/PudMed aiming to search papers relative to prospective trials, retrospective studies, case series, and case reports of interest in order to investigate current knowledge toward the main clinical and molecular characteristics, radiology, and diagnosis, loco-regional and systemic treatments of these tumors. Moreover, we also evaluated the novel treatments under investigation. EXPERT OPINION Thanks to an increased knowledge of the genomic landscape of these rare tumors, there are novels promising therapeutic targets for these malignancies. However, the majority of available trials allowed enrollment only in DMG, while few studies are focused on or allow the inclusion of DHG patients.
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Affiliation(s)
| | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Italy
| | - Lidia Gatto
- Department of Oncology, AUSL Bologna, Bologna, Italy
| | - Alicia Tosoni
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Italy
| | - Stefania Bartolini
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Italy
| | - Alba Ariela Brandes
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Italy
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14
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Lasocki A, Abdalla G, Chow G, Thust SC. Imaging features associated with H3 K27-altered and H3 G34-mutant gliomas: a narrative systematic review. Cancer Imaging 2022; 22:63. [DOI: 10.1186/s40644-022-00500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/23/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Advances in molecular diagnostics accomplished the discovery of two malignant glioma entities harboring alterations in the H3 histone: diffuse midline glioma, H3 K27-altered and diffuse hemispheric glioma, H3 G34-mutant. Radiogenomics research, which aims to correlate tumor imaging features with genotypes, has not comprehensively examined histone-altered gliomas (HAG). The aim of this research was to synthesize the current published data on imaging features associated with HAG.
Methods
A systematic search was performed in March 2022 using PubMed and the Cochrane Library, identifying studies on the imaging features associated with H3 K27-altered and/or H3 G34-mutant gliomas.
Results
Forty-seven studies fulfilled the inclusion criteria, the majority on H3 K27-altered gliomas. Just under half (21/47) were case reports or short series, the remainder being diagnostic accuracy studies. Despite heterogeneous methodology, some themes emerged. In particular, enhancement of H3 K27M-altered gliomas is variable and can be less than expected given their highly malignant behavior. Low apparent diffusion coefficient values have been suggested as a biomarker of H3 K27-alteration, but high values do not exclude this genotype. Promising correlations between high relative cerebral blood volume values and H3 K27-alteration require further validation. Limited data on H3 G34-mutant gliomas suggest some morphologic overlap with 1p/19q-codeleted oligodendrogliomas.
Conclusions
The existing data are limited, especially for H3 G34-mutant gliomas and artificial intelligence techniques. Current evidence indicates that imaging-based predictions of HAG are insufficient to replace histological assessment. In particular, H3 K27-altered gliomas should be considered when occurring in typical midline locations irrespective of enhancement characteristics.
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15
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Adult diffuse midline gliomas H3 K27-altered: review of a redefined entity. J Neurooncol 2022; 158:369-378. [PMID: 35567713 DOI: 10.1007/s11060-022-04024-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Diffuse midline glioma (DMG) H3 K27-altered is a type of high-grade gliomas first recognized as a new entity in the 2016 World Health Organization Classification of Central Nervous System (CNS) Tumors as DMG H3 K27M-mutant, recently renamed in the new 2021 WHO classification. The aim of this review is to describe the characteristics of diffuse midline gliomas H3 K27-altered in the adult population. METHODS We performed a review of the current literature regarding the genetic, clinical, imaging characteristics and management of diffuse midline gliomas H3 K27-altered in adult patients. RESULTS The 2021 WHO classification now designates the previously recognized DMG H3K27M-mutant as DMG H3 K27-altered, recognizing the alternative mechanisms by which the pathogenic pathway can be altered. Thus, the diagnostic criteria for this entity consist of diffuse growth pattern, midline anatomic location, and H3 K27-specific neuroglial mutations. DMGs' characteristic midline location makes them difficult to surgically resect and biopsy, carrying high mortality and morbidity rates, with median survival ranging from 9 to 12 months in adult patients. CONCLUSION The diagnosis of DMGs H3 K27-altered in adult patients should be considered upon neurological symptoms associated with an infiltrative midline brain tumor detected on imaging. Future studies are necessary to continue refining their characteristics in this age group.
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Prediction of H3 K27M-mutant in midline gliomas by magnetic resonance imaging: a systematic review and meta-analysis. Neuroradiology 2022; 64:1311-1319. [PMID: 35416485 DOI: 10.1007/s00234-022-02947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To summarize the predictive value of MRI for H3 K27M-mutant in midline gliomas using meta-analysis. METHODS Systematic electronic searches of the PubMed, Embase, ISI Web of Science, and Cochrane Library up to Jun 31, 2021, were conducted by two experienced neuroradiologists with the keywords of "MRI," "Glioma," and "H3 K27M." The hierarchical summary receiver-operating characteristic (HSROC) model was used to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR +), negative likelihood ratio (LR -), and diagnostic odds ratio (DOR). Coupled forest plots were used to evaluate the heterogeneity of the included studies. RESULTS Of seven original studies with a total of 593 patients, 240 glioma patients were included, with 45.5-70.6% H3 K27M-mutant gliomas. Using MRI, a pooled sensitivity of 0.78 (95% CI, 0.66-0.87), specificity of 0.85 (95% CI, 0.76-0.91), LR + of 5.07 (95% CI, 3.19-8.08), LR - of 0.26 (95% CI, 0.16-0.42), and DOR of 19.80 (95% CI, 9.28-42.28) were achieved for H3 K27M-mutant prediction. Significant heterogeneity was observed among the studies in terms of sensitivity (Q = 16.83, df = 7, p = 0.02; I2 = 58.40 [95% CI, 25.83-90.97]), LR - (Q = 16.61, df = 7, p = 0.02; I2 = 57.87 [95% CI, 24.81-90.93]), and DOR (Q = 14.05, df = 7, p = 0.05; I2 = 50.18 [95% CI, 10.06-90.31]). CONCLUSIONS This meta-analysis demonstrated a clinical value of MRI to predict H3 K27M-mutant in midline gliomas with a pooled sensitivity of 0.78 and specificity of 0.85.
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Ikeda K, Kolakshyapati M, Takayasu T, Amatya VJ, Takano M, Yonezawa U, Taguchi A, Onishi S, Takeshima Y, Sugiyama K, Yamasaki F. Diffusion-weighted imaging-gadolinium enhancement mismatch sign in diffuse midline glioma. Eur J Radiol 2022; 147:110103. [DOI: 10.1016/j.ejrad.2021.110103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
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Kurokawa R, Kurokawa M, Baba A, Ota Y, Kim J, Capizzano A, Srinivasan A, Moritani T. Dynamic susceptibility contrast-MRI parameters, ADC values, and the T2-FLAIR mismatch sign are useful to differentiate between H3-mutant and H3-wild-type high-grade midline glioma. Eur Radiol 2022; 32:3672-3682. [PMID: 35022811 DOI: 10.1007/s00330-021-08476-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/25/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Diffuse midline gliomas, H3K27-altered (DMG-A), are malignant gliomas with an unfavorable prognosis. Knowledge of dynamic susceptibility contrast (DSC) MRI findings and imaging differences with high-grade midline glioma without H3K27 alteration (DMG-W) has been limited. We compared the DSC, ADC, and conventional MRI findings between DMG-A and DMG-W. METHODS In this single institutional retrospective study, the electronic database of our hospital between June 2015 and May 2021 was searched. Twenty and 17 patients with DMG-A (median, 13 years; range, 3-52 years; 11 females) and DMG-W (median, 40 years; 7-73 years; 9 females), respectively, were found. Normalized relative cerebral blood flow (nrCBF) and normalized corrected relative cerebral blood volume (ncrCBV); normalized maximum, mean, and minimum ADC values; and the prevalence of T2-FLAIR mismatch sign were compared between the two groups using Mann-Whitney U tests and Fisher's exact test. RESULTS The nrCBF and ncrCBV were significantly lower in DMG-A compared with DMG-W (nrCBF: median 0.88 [range, 0.19-2.67] vs. 1.47 [range, 0.57-4.90] (p < 0.001); ncrCBV: 1.17 [0.20-2.67] vs. 1.56 [0.60-4.03] (p = 0.008)). Normalized maximum ADC (nADCmax) was significantly higher in DMG-A (median 2.37 [1.25-3.98] vs. 1.95 [1.23-2.77], p = 0.02). T2-FLAIR mismatch sign was significantly more common in DMG-A (11/20 (55.0%) vs. 1/17 (5.9%), p = 0.0017). When at least two of nrCBF < 1.11, nADCmax ≥ 2.48, and T2-FLAIR mismatch sign were positive, the diagnostic performance was the highest with accuracy of 0.81. CONCLUSION DSC-MRI parameters, ADC values, and the T2-FLAIR mismatch sign are useful to differentiate between DMG-A and DMG-W. KEY POINTS • Diffuse midline glioma, H3K27-altered (DMG-A), showed a significantly lower normalized relative cerebral blood flow and volume compared with H3K27-wild-type counterparts (DMG-W). • T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign was significantly more frequent in DMG-A compared to DMG-W. • Indicators that combined DSC parameters, ADC values, and T2-FLAIR mismatch sign, with or without age, are useful to distinguish the two tumors.
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Affiliation(s)
- Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - John Kim
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aristides Capizzano
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
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Dixon L, Jandu GK, Sidpra J, Mankad K. Diagnostic accuracy of qualitative MRI in 550 paediatric brain tumours: evaluating current practice in the computational era. Quant Imaging Med Surg 2022; 12:131-143. [PMID: 34993066 DOI: 10.21037/qims-20-1388] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate the accuracy of qualitative reporting of conventional magnetic resonance imaging (MRI) in the classification of paediatric brain tumours. METHODS Preoperative MRI reports of 608 children prior to resection or biopsy of an intracranial lesion were retrospectively reviewed. A total of 550 children had complete radiological and histopathological notes, thereby reaching our inclusion criteria. Concordance between MRI report and final histopathological diagnosis was assessed using an established lexicon derived from the WHO 2016 classification of CNS tumours. Levels of agreement based on cellular origin, tumour type, and tumour grade were evaluated. Diagnostic accuracy, sensitivity, specificity, confidence intervals, and positive and negative predictive values were calculated. RESULTS Diagnostic accuracy differed significantly between tumour types and tumour grades. Sensitivities were highest for ependymomas and sellar, pituitary, pineal, and cranial and/or paraspinal nerve tumours (range 80.65-100%). Sensitivity was slightly lower for astrocytic gliomas, oligodendrogliomas, and choroid plexus, neuronal, mixed neuronal-glial, embryonal, and histiocytic tumours (range 63.33-79.59%). Low sensitivities were noted for meningiomas and mesenchymal non-meningothelial, melanocytic, and germ cell tumours (range 0-56.25%). The most correct tumour type predictions were made in the posterior fossa whilst the most incorrect predictions were made in the lobar regions, pineal/tectal plate area, and the supratentorial ventricles. CONCLUSIONS This is the largest published series investigating the predictive accuracy of MRI in paediatric brain tumours. We show that diagnostic accuracy varies greatly by tumour type and location. Looking forward, we should develop and leverage computational methods to improve accuracy in the tumour types and anatomical locations where qualitative diagnostic accuracy is lower.
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Affiliation(s)
- Luke Dixon
- Department of Neuroradiology, Imperial University Healthcare NHS Foundation Trust, London, UK
| | | | - Jai Sidpra
- Developmental Biology and Cancer Section, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Developmental Biology and Cancer Section, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Hohm A, Karremann M, Gielen GH, Pietsch T, Warmuth-Metz M, Vandergrift LA, Bison B, Stock A, Hoffmann M, Pham M, Kramm CM, Nowak J. Magnetic Resonance Imaging Characteristics of Molecular Subgroups in Pediatric H3 K27M Mutant Diffuse Midline Glioma. Clin Neuroradiol 2021; 32:249-258. [PMID: 34919158 PMCID: PMC8894220 DOI: 10.1007/s00062-021-01120-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
Purpose Recent research identified histone H3 K27M mutations to be associated with a dismal prognosis in pediatric diffuse midline glioma (pDMG); however, data on detailed MRI characteristics with respect to H3 K27 mutation status and molecular subgroups (H3.1 and H3.3 K27M mutations) are limited. Methods Standardized magnetic resonance imaging (MRI) parameters and epidemiologic data of 68 pDMG patients (age <18 years) were retrospectively reviewed and compared in a) H3 K27M mutant versus H3 K27 wildtype (WT) tumors and b) H3.1 versus H3.3 K27M mutant tumors. Results Intracranial gliomas (n = 58) showed heterogeneous phenotypes with isointense to hyperintense signal in T2-weighted images and frequent contrast enhancement. Hemorrhage and necrosis may be present. Comparing H3 K27M mutant to WT tumors, there were significant differences in the following parameters: i) tumor localization (p = 0.001), ii) T2 signal intensity (p = 0.021), and iii) T1 signal homogeneity (p = 0.02). No significant imaging differences were found in any parameter between H3.1 and H3.3 K27M mutant tumors; however, H3.1 mutant tumors occurred at a younger age (p = 0.004). Considering spinal gliomas (n = 10) there were no significant imaging differences between the analyzed molecular groups. Conclusion With this study, we are the first to provide detailed MR imaging data on H3 K27M mutant pDMG with respect to molecular subgroup status in a large patient cohort. Our findings may support diagnosis and future targeted therapeutic trials of pDMG within the framework of the radiogenomics concept. Supplementary Information The online version of this article (10.1007/s00062-021-01120-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Hohm
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
- Current address: Division of Pediatric Stem Cell Transplantation and Immunology, University Children's Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Karremann
- Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gerrit H Gielen
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Monika Warmuth-Metz
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Lindsey A Vandergrift
- Departments of Radiology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brigitte Bison
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Current address: Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Department of Neuroradiology, University Augsburg, Faculty of Medicine, Augsburg, Germany
| | - Annika Stock
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Marion Hoffmann
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Mirko Pham
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Nowak
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany.
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany.
- SRH Poliklinik Gera GmbH, Radiology Gotha, Gotha, Germany.
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Wei RL, Wei XT. Advanced Diagnosis of Glioma by Using Emerging Magnetic Resonance Sequences. Front Oncol 2021; 11:694498. [PMID: 34422648 PMCID: PMC8374052 DOI: 10.3389/fonc.2021.694498] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Glioma, the most common primary brain tumor in adults, can be difficult to discern radiologically from other brain lesions, which affects surgical planning and follow-up treatment. Recent advances in MRI demonstrate that preoperative diagnosis of glioma has stepped into molecular and algorithm-assisted levels. Specifically, the histology-based glioma classification is composed of multiple different molecular subtypes with distinct behavior, prognosis, and response to therapy, and now each aspect can be assessed by corresponding emerging MR sequences like amide proton transfer-weighted MRI, inflow-based vascular-space-occupancy MRI, and radiomics algorithm. As a result of this novel progress, the clinical practice of glioma has been updated. Accurate diagnosis of glioma at the molecular level can be achieved ahead of the operation to formulate a thorough plan including surgery radical level, shortened length of stay, flexible follow-up plan, timely therapy response feedback, and eventually benefit patients individually.
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Affiliation(s)
- Ruo-Lun Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-Ting Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Cheng R, Li DP, Zhang N, Zhang JY, Zhang D, Liu TT, Yang J, Ge M. Spinal Cord Diffuse Midline Glioma With Histone H3 K27M Mutation in a Pediatric Patient. Front Surg 2021; 8:616334. [PMID: 34222313 PMCID: PMC8245756 DOI: 10.3389/fsurg.2021.616334] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Diffuse midline glioma (DMG) with histone H3 K27M mutation is a recently identified entity documented in the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System. Spinal cord DMGs with H3 K27M-mutant are commonly reported in adults. Herein, we reported a pediatric patient with spinal cord H3 K27M-mutant DMG. Case Report: A 7-year-old girl with 1-month history of neck pain and 3-week history of progressive weakness in the right hand was presented. Spinal magnetic resonance imaging showed an intramedullary lesion with slight enhancement at the C2-7 levels. With intraoperative neuroelectrophysiological monitoring, the lesion was subtotally resected. Histopathological examination revealed a DMG with histone H3 K27M mutation corresponding to WHO grade IV. Postoperatively, the neck pain was relieved, and the upper-extremity weakness remained unchanged. Oral temozolomide was administrated for 7 months, and radiotherapy was performed for 22 courses. After an 18-month follow-up, no tumor recurrence was noted. Conclusion: Spinal cord H3 K27M-mutant DMGs are extremely rare in pediatric patients. Preoperative differential diagnosis is challenging, and surgical resection with postoperative chemoradiotherapy may be an effective treatment.
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Affiliation(s)
- Ran Cheng
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Da-Peng Li
- Department of Neurosurgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Pathology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ji-Yin Zhang
- Department of Otolaryngology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Di Zhang
- Department of Neurosurgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Liu
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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