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Differences in the MRI Signature and ADC Values of Diffuse Midline Gliomas with H3 K27M Mutation Compared to Midline
Peter Raab1, Rouzbeh Banan2, Arash Akbarian3
1Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany.
Abstract:
We conducted a two-center retrospective survey on standard MRI features including apparent diffusion coefficient mapping (ADC) of diffuse midline gliomas H3 K27M-mutant (DMG) compared to midline glioblastomas H3 K27M-wildtype (midGBM-H3wt). We identified 39 intracranial DMG and 18 midGBM-H3wt tumors. Samples were microscopically re-evaluated for microvascular proliferations and necrosis. Image analysis focused on location, peritumoral edema, degree of contrast enhancement and DWI features. Within DMG, MRI features between tumors with or without histomorphological GBM features were compared. DMG occurred in 15/39 samples from the thalamus (38%), in 23/39 samples from the brainstem (59%) and in 1/39 tumors involving primarily the cerebellum (2%). Edema was present in 3/39 DMG cases (8%) versus 78% in the control (midGBM-H3wt) group (p < 0.001). Contrast enhancement at the tumor rim was detected in 17/39 DMG (44%) versus 67% in control (p = 0.155), and necrosis in 24/39 (62%) versus 89% in control (p = 0.060). Strong contrast enhancement was observed in 15/39 DMG (38%) versus 56% in control (p = 0.262). Apparent diffusion coefficient (ADC) histogram analysis showed significantly higher skewness and kurtosis values in the DMG group compared to the controls (p = 0.0016/p = 0.002). Minimum relative ADC (rADC) values, as well as the 10th and 25th rADC-percentiles, were lower in DMGs with GBM features within the DMG group (p < 0.001/p = 0.012/p = 0.027). In conclusion, DMG cases exhibited markedly less edema than midGBM-H3wt, even if histomorphological malignancy was present. Histologically malignant DMGs and midGBM-H3wt more often displayed strong enhancement, as well as rim enhancement, than DMGs without histomorphological malignancy. DMGs showed higher skewness and kurtosis values on ADC-histogram analysis compared to midGBM-H3wt. Lower minimum rADC values in DMGs indicated malignant histomorphological features, likely representing a more complex tissue microstructure.
Insights
Diffuse midline gliomas (DMG) show significantly less edema on MRI compared to midline glioblastomas (midGBM-H3wt). Apparent diffusion coefficient (ADC) histogram analysis reveals distinct patterns in DMG, indicating complex tissue microstructure.
Area of Science:
- Neuroradiology
- Oncology
- Medical Imaging
Background:
- Diffuse midline gliomas (DMG) are aggressive brain tumors often associated with the H3 K27M mutation.
- Distinguishing DMG from other midline tumors like midline glioblastomas (midGBM-H3wt) is crucial for diagnosis and treatment planning.
- Standard MRI features can be variable, necessitating advanced imaging techniques for better characterization.
Purpose of the Study:
- To compare standard MRI features and apparent diffusion coefficient (ADC) mapping between diffuse midline gliomas H3 K27M-mutant (DMG) and midline glioblastomas H3 K27M-wildtype (midGBM-H3wt).
- To investigate MRI characteristics differentiating between DMGs with and without histomorphological glioblastoma (GBM) features.
- To evaluate the utility of ADC histogram analysis in characterizing DMG.
Main Methods:
- Retrospective two-center survey of 39 DMG and 18 midGBM-H3wt cases.
- Analysis of standard MRI features: location, peritumoral edema, contrast enhancement, and diffusion-weighted imaging (DWI).
- Apparent diffusion coefficient (ADC) histogram analysis, including skewness, kurtosis, and relative ADC (rADC) percentiles.
Main Results:
- DMG cases exhibited significantly less peritumoral edema (8%) compared to midGBM-H3wt (78%) (p < 0.001).
- ADC histogram analysis showed significantly higher skewness and kurtosis values in DMG compared to controls (p = 0.0016/p = 0.002).
- Lower minimum rADC values in DMGs with GBM features suggested a more complex tissue microstructure.
Conclusions:
- DMG cases demonstrate markedly less edema than midGBM-H3wt, irrespective of histomorphological malignancy.
- Histologically malignant DMGs and midGBM-H3wt more frequently display strong and rim enhancement.
- ADC histogram analysis, particularly skewness, kurtosis, and rADC values, aids in differentiating DMG and identifying malignant features within DMGs.
