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Published on: November 11, 2021
MRI Evaluation of Non-Necrotic T2-Hyperintense Foci in Pediatric Diffuse Intrinsic Pontine Glioma
O Clerk-Lamalice1, W E Reddick1, X Li2
1From the Departments of Diagnostic Imaging (O.C.-L., W.E.R., A.E., J.O.G., Z.P.).
Background And Purpose:
The conventional MR imaging appearance of diffuse intrinsic pontine glioma suggests intralesional histopathologic heterogeneity, and various distinct lesion components, including T2-hypointense foci, have been described. Here we report the prevalence, conventional MR imaging semiology, and advanced MR imaging features of non-necrotic T2-hyperintense foci in diffuse intrinsic pontine glioma.
Materials And Methods:
Twenty-five patients with diffuse intrinsic pontine gliomas were included in this study. MR imaging was performed at 3T by using conventional and advanced MR imaging sequences. Perfusion (CBV), vascular permeability (ve, Ktrans), and diffusion (ADC) metrics were calculated and used to characterize non-necrotic T2-hyperintense foci in comparison with other lesion components, namely necrotic T2-hyperintense foci, T2-hypointense foci, peritumoral edema, and normal brain stem. Statistical analysis was performed by using Kruskal-Wallis and Wilcoxon rank sum tests.
Results:
Sixteen non-necrotic T2-hyperintense foci were found in 12 tumors. In these foci, ADC values were significantly higher than those in either T2-hypointense foci (P = .002) or normal parenchyma (P = .0002), and relative CBV values were significantly lower than those in either T2-hypointense (P = .0002) or necrotic T2-hyperintense (P = .006) foci. Volume transfer coefficient values in T2-hyperintense foci were lower than those in T2-hypointense (P = .0005) or necrotic T2-hyperintense (P = .0348) foci.
Conclusions:
Non-necrotic T2-hyperintense foci are common, distinct lesion components within diffuse intrinsic pontine gliomas. Advanced MR imaging data suggest low cellularity and an early stage of angioneogenesis with leaky vessels resulting in expansion of the extracellular space. Because of the lack of biopsy validation, the underlying histoarchitectural and pathophysiologic changes remain unclear; therefore, these foci may correspond to a poorly understood biologic event in tumor evolution.
Insights
Non-necrotic T2-hyperintense foci are common in diffuse intrinsic pontine gliomas. Advanced MRI suggests these areas have low cellularity and early angiogenesis, but their exact nature remains unclear.
Area of Science:
- Neuroradiology
- Pediatric Oncology
- Neuro-oncology
Background:
- Diffuse intrinsic pontine glioma (DIPG) exhibits histopathologic heterogeneity on conventional MRI.
- T2-hypointense foci are recognized components, but non-necrotic T2-hyperintense foci also exist.
Purpose of the Study:
- To report the prevalence and conventional MRI characteristics of non-necrotic T2-hyperintense foci in DIPG.
- To investigate advanced MRI features of these foci.
Main Methods:
- 25 DIPG patients underwent 3T MRI with conventional and advanced sequences.
- Perfusion (CBV), vascular permeability (Ktrans), and diffusion (ADC) metrics were calculated.
- Non-necrotic T2-hyperintense foci were compared to other lesion components and normal brain stem.
Main Results:
- 16 non-necrotic T2-hyperintense foci were identified in 12 tumors.
- These foci showed significantly higher ADC values than T2-hypointense foci or normal parenchyma.
- Relative CBV and Ktrans values were lower compared to other lesion components.
Conclusions:
- Non-necrotic T2-hyperintense foci are common, distinct components of DIPG.
- Advanced MRI suggests low cellularity and early, leaky angiogenesis.
- The precise histopathologic nature remains unclear, possibly representing an early tumor evolution event.
