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Updated: May 31, 2026
A Protocol for Rapid Post-mortem Cell Culture of Diffuse Intrinsic Pontine Glioma (DIPG)
Published on: March 7, 2017
Predicting outcome of children with diffuse intrinsic pontine gliomas using multiparametric imaging
Sean J Hipp1, Emilie Steffen-Smith, Dima Hammoud
1Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD 20892, USA. sean.hipp@us.army.mil
Insights
Dynamic susceptibility contrast MRI and single-voxel spectroscopy can predict survival in children with diffuse intrinsic pontine gliomas (DIPG). Increased perfusion and specific metabolite ratios on MRI indicate shorter survival for DIPG patients.
Area of Science:
- Pediatric Oncology
- Neuroradiology
- Medical Imaging
Background:
- Magnetic resonance imaging (MRI) is crucial for assessing pediatric diffuse intrinsic pontine gliomas (DIPGs).
- Currently, no standard MRI sequence reliably predicts outcomes in DIPG patients.
- There is a need for prognostic imaging biomarkers in DIPG management.
Purpose of the Study:
- To evaluate the combined prognostic value of dynamic susceptibility contrast (DSC) MRI, single-voxel spectroscopy (SVS), multivoxel MR spectroscopy (MRS), and T1-weighted post-gadolinium imaging in children with DIPG.
- To identify specific MRI parameters that correlate with patient survival.
Main Methods:
- Retrospective analysis of 98 MRI studies from 34 children diagnosed with DIPG.
- Utilized DSC-MRI, SVS, MRS, and post-gadolinium T1-weighted imaging at various time points.
- Statistical evaluation included Cox proportional hazard models, time-dependent covariant Cox models, Wald tests, and Kaplan-Meier analysis.
Main Results:
- Increased choline to n-acetylaspartate ratio (Cho:NAA) on SVS and increased perfusion on DSC-MRI at baseline predicted shorter survival.
- At subsequent time points, increased maximum Cho:NAA on MRS, increased Cho:NAA on SVS, increased perfusion, and presence of enhancement were associated with shorter survival.
- Increased perfusion at any time point was a significant predictor of shorter survival (P = .0004 at baseline).
Conclusions:
- Dynamic susceptibility contrast MRI and single-voxel spectroscopy are valuable prognostic tools for children with DIPG.
- Routine baseline and follow-up imaging should incorporate DSC-MRI and SVS to assess DIPG patient outcomes.
- Enhancement and specific metabolic changes (Cho:NAA) also provide prognostic information over time.
Abstract:
Noninvasive evaluation using MRI is the primary means to routinely assess children with diffuse intrinsic pontine gliomas (DIPGs). However, no standard MR sequence has correlated with outcome in these patients. In this study, patients with DIPGs were assessed to determine the combined prognostic value via dynamic susceptibility contrast (DSC) MRI, single-voxel spectroscopy (SVS), multivoxel MR spectroscopy (MRS), and T1-weighted post-gadolinium imaging. Eligible patients had clinical and radiographic findings consistent with a DIPG. Imaging studies were acquired on a 1.5T MRI at various time points during each patient's course. Data were evaluated using a Cox proportional hazard model, a time-dependent covariant Cox model, a Wald test, and a Kaplan-Meier analysis. Ninety-eight studies were performed on 34 patients of median age 5.5 years. Median survival from diagnosis was 468 days. At baseline imaging only, increased ratio of choline to n-acetylaspartate (Cho:NAA) on SVS and increased perfusion on DSC-MRI each predicted shorter survival (relative risk [RR] = 1.48, P = .015 and RR = 4.91, P = .0012, respectively). When analyzing all subsequent time points, increased maximum Cho:NAA on MRS (RR = 1.45, P = .042), increased Cho:NAA on SVS (RR = 1.69, P = .003), increased perfusion (RR = 4.68, P = .0016), and the presence of enhancement (RR = 5.69, P = .022) each predicted shorter survival. Kaplan-Meier analysis showed shorter survival associated with increased perfusion at baseline (P = .0004). Increased perfusion at any time point predicts a significantly shorter survival in children with DIPG. In addition, enhancement, increased Cho:NAA on SVS, and increased maximum Cho:NAA on chemical shift imaging are predictive of shorter survival over time. Routine baseline and subsequent imaging for children with DIPG should, at minimum, incorporate DSC-MRI and SVS.
