Identification of prognostic imaging biomarkers in H3 K27-altered diffuse midline gliomas in adults: impact of tumor oxygenation imaging biomarkers on survival

Yongsik Sim ^1,2, Kaeum Choi ³, Kyunghwa Han ¹

⁰Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.

Neuroradiology +

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July 15, 2024

View abstract on PubMed

Summary

Leptomeningeal metastases (LM) predict poor prognosis in adult H3 K27-altered diffuse midline gliomas (DMGs). In contrast-enhancing tumors, higher relative cerebral metabolic rate of oxygen (rCMRO2) also indicates a worse outcome.

Area Of Science

Neuro-oncology
Radiology
Oncology

Background

Diffuse midline gliomas (DMGs) with H3 K27 alterations are aggressive brain tumors.
Identifying prognostic markers is crucial for managing adult patients with these rare tumors.

Purpose Of The Study

To investigate clinical, qualitative, and quantitative imaging markers, including tumor oxygenation, for predicting prognosis in adult H3 K27-altered DMGs.
To identify independent predictors of overall survival (OS).

Main Methods

Retrospective review of 32 adult patients with H3 K27-altered DMGs.
Analysis of clinical and qualitative imaging features.
Quantitative imaging assessment of tumor oxygenation (nCBV, CTH, OEF, rCMRO2) and ADC values.
Cox proportional hazards models to identify predictors of OS.

Main Results

Leptomeningeal metastases (LM) were the sole independent predictor of OS in all patients (HR=6.01, P=0.009).
In patients with contrast-enhancing (CE) tumors, LM (HR=5.92, P=0.043) and higher rCMRO2 (HR=1.08, P=0.019) independently predicted poor OS.

Conclusions

Leptomeningeal metastases (LM) are a significant independent predictor of poor prognosis in adult H3 K27-altered DMG.
Elevated rCMRO2 in CE tumors may serve as a valuable imaging biomarker for predicting poor prognosis, reflecting increased metabolic activity and altered tumor oxygenation.

Keywords:

Cerebral metabolic rate of oxygen Diffuse midline glioma Magnetic resonance imaging Survival analysis