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Preoperative Recurrence Risk Stratification in Pleomorphic Xanthoastrocytoma Using VASARI MRI Features: A Dual-Center
Shuang Li1, Shuang Chen1, Xin Fang1
1From the Department of Radiology (S.L., X.F., Y.J., Q.Y.), West China Hospital of Sichuan University, Chengdu, China and Department of Radiology (S.C., Y.L.), Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China.
AJNR. American Journal of Neuroradiology
|July 24, 2026
Summary
A new model using MRI features can predict pleomorphic xanthoastrocytoma (PXA) recurrence risk before surgery. This tool aids in stratifying patients and guiding treatment decisions for this rare brain tumor.
Area of Science:
- Neuro-oncology
- Radiology
- Medical imaging
Background:
- Pleomorphic xanthoastrocytoma (PXA) recurrence risk is unpredictable, lacking preoperative stratification tools.
- A need exists for reliable methods to assess PXA recurrence risk before treatment.
Purpose of the Study:
- To develop and validate a predictive model for PXA recurrence using Visually Accessible Rembrandt Images (VASARI) MRI features.
- To identify specific MRI characteristics associated with PXA tumor recurrence.
Main Methods:
- Retrospective analysis of 155 PXA patients, with 116 in the survival cohort.
- Assessment of 27 VASARI features by two radiologists; Cox proportional hazards regression for recurrence predictors.
- Model discrimination evaluated using Harrell's concordance index (C-index) and calibration with Brier score.
Main Results:
- Tumor recurrence observed in 23.3% of patients.
- Independent predictors of recurrence identified: diffusion restriction, midline crossing, and mixed cystic-solid morphology.
- The three-feature model demonstrated good discrimination (C-index=0.79).
Conclusions:
- A three-feature VASARI-based model shows promise for preoperative PXA recurrence risk stratification.
- The model is accessible, not requiring specialized software.
- Further independent external validation is necessary before clinical implementation.