Related Experiment Video
Updated: Oct 6, 2025
Digital Spatial Profiling for Characterization of the Microenvironment in Adult-Type Diffusely Infiltrating Glioma
Published on: September 13, 2022
Diffusion-weighted imaging-gadolinium enhancement mismatch sign in diffuse midline glioma
Koki Ikeda1, Manish Kolakshyapati2, Takeshi Takayasu3
1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, National Hospital Organization, Higashihiroshima Medical Center, Hiroshima, Japan.
Background:
Diffuse midline glioma (DMG), H3 K27M-mutant including diffuse intrinsic pontine glioma (DIPG) is a disease with dismal prognosis. We focused on diffusion-weighted imaging (DWI) and gadolinium enhanced T1WI (Gd), especially high intensity on DWI at non-enhanced lesion, i.e. DWI-Gd mismatch sign, to establish as an imaging biomarker of DMG patients.
Materials And Methods:
Our institutional review board approved this retrospective study. Twenty-one patients diagnosed as DMG including DIPG at our institution between 2007 and 2020 were enrolled in this study. All patients underwent local radiotherapy of 54 Gy/30 fractions. We studied the relationship between imaging features including DWI-Gd mismatch sign and prognosis.
Results:
DWI-Gd mismatch sign was found in 9 out of 21 DMG patients. Among different imaging characteristics, existence of high intensity on DWI (P = 0.0014), gadolinium enhancement (P = 0.00071) were the significant poor prognostic markers in DMG, which were consistent with the previous reports about DIPG. In our results, positive DWI-Gd mismatch sign was statistically strongest poor prognostic imaging biomarker, and patients with positive DWI-Gd mismatch sign had shorter OS compared to those with negative mismatch sign (9.9 months vs 18.6 months, P = 0.00062). DWI/Gd mismatch sign and intratumoral bleeding were more common in DMG at thalamus compared to DMG at pons/DIPG (P = 0.046 and P = 0.0017, respectively).
Conclusions:
DWI-Gd mismatch sign may be an imaging biomarker for poor prognosis in DMG. (E-1601).
Insights
The DWI-Gd mismatch sign is a strong imaging biomarker for poor prognosis in diffuse midline glioma (DMG), including diffuse intrinsic pontine glioma (DIPG). Patients with this sign had significantly shorter overall survival, highlighting its clinical significance.
Area of Science:
- Neuro-oncology
- Radiology
- Medical Imaging
Background:
- Diffuse midline glioma (DMG), including diffuse intrinsic pontine glioma (DIPG), presents a poor prognosis.
- Diffusion-weighted imaging (DWI) and gadolinium-enhanced T1-weighted imaging (Gd-T1WI) are key MRI techniques.
- The DWI-Gd mismatch sign, characterized by high DWI intensity in non-enhanced lesions, is explored as a potential imaging biomarker.
Purpose of the Study:
- To investigate the prognostic value of the DWI-Gd mismatch sign in DMG patients.
- To establish imaging biomarkers for predicting outcomes in diffuse midline glioma.
Main Methods:
- Retrospective study of 21 DMG patients (including DIPG) diagnosed between 2007 and 2020.
- Analysis of imaging features, specifically the DWI-Gd mismatch sign, in relation to patient prognosis.
- Correlation of imaging findings with overall survival (OS) after radiotherapy.
Main Results:
- The DWI-Gd mismatch sign was identified in 9 out of 21 DMG patients.
- High DWI intensity and gadolinium enhancement were significant poor prognostic markers.
- Positive DWI-Gd mismatch sign was the strongest predictor of poor prognosis, with shorter OS (9.9 months vs. 18.6 months).
- DWI/Gd mismatch sign and intratumoral bleeding were more frequent in thalamic DMG compared to pontine/DIPG.
Conclusions:
- The DWI-Gd mismatch sign shows potential as a valuable imaging biomarker for predicting poor prognosis in diffuse midline glioma.
- This finding can aid in risk stratification and treatment planning for DMG patients.
Related Concept Videos
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
01:24Magnetic Resonance Imaging