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Pathology-MRI Correlations in Diffuse Low-Grade Epilepsy Associated Tumors
Aliya Al-Hajri1, Salim Al-Mughairi1, Alyma Somani1
1Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK; Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK; and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Journal of Neuropathology and Experimental Neurology
|October 18, 2017
Summary
Diffuse glioneuronal tumors (dGNT) are distinct from dysembryoplastic neuroepithelial tumors (DNT). MRI reliably differentiates dGNT from DNT, aiding surgical planning for low-grade epilepsy associated tumors.
Area of Science:
- Neuroncology
- Neuroimaging
- Pathology
Background:
- Low-grade epilepsy associated tumors (LEAT) lacking IDH mutation can present with diffuse growth patterns.
- These tumors often lack features of classical dysembryoplastic neuroepithelial tumors (DNT) or ganglioglioma, leading to varied terminology like "nonspecific or diffuse DNT" or "polymorphous low-grade neuroepithelial tumor of the young."
- Accurate magnetic resonance imaging (MRI) recognition of diffuse glioneuronal tumors (dGNT) is crucial for surgical resection planning.
Purpose of the Study:
- To evaluate the MRI characteristics of dGNT.
- To assess the reliability of MRI in differentiating dGNT from DNT.
- To correlate MRI findings with histopathological features.
Main Methods:
- Retrospective analysis of 27 LEATs with T1, T2, FLAIR, and postcontrast T1 MRI.
- Pathological review including immunostaining for NeuN, CD34, MAP2, and IDH1.
- Independent classification of cases by pathology and MRI into simple DNT, complex DNT, or dGNT.
Main Results:
- High agreement (85%, Kappa=0.62) between MRI and pathology classifications.
- 100% agreement for dGNT diagnosis, with discrepancies mainly between simple and complex DNT.
- DNT showed more cortical expansion, cystic change, and ventricle extension compared to dGNT.
- dGNT exhibited more subcortical T2 hyperintensity and focal cortical atrophy, correlating with CD34 expression, neuronal loss, and white matter rarefaction.
Conclusions:
- MRI can reliably discriminate dGNT from DNT.
- Specific MRI features like subcortical T2 hyperintensity and focal cortical atrophy are indicative of dGNT.
- No distinct cortical dysplasia component was identified in any case by MRI or pathology.