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Published on: November 11, 2021
Preoperative Prediction of H3 K27 Alteration Status in Diffuse Midline Glioma Using Intravoxel Incoherent Motion
1Department of Radiology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, PR China (W.G., Y.S., Y.P., M.T., P.H., X.L., D.S.); Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, PR China (W.G., Y.S., Y.P., M.T., X.L., D.S.).
Rationale And Objectives:
The H3 K27 alteration status of diffuse midline gliomas (DMGs) is critical for prognosis and therapeutic decision-making but currently relies on invasive tissue sampling.
Materials And Methods:
153 patients (126 adults) with DMG who underwent intravoxel incoherent motion (IVIM) examinations were retrospectively included. DMGs were divided into H3 K27-altered (H3 K27-A) and wild-type (H3 K27-WT) groups. The DMGs were divided into three habitats (habitat 1-low diffusion and perfusion, habitat 2 -high diffusion and low perfusion, habitat 3-high perfusion) based on perfusion fraction and true diffusion coefficient maps. The quantitative parameters of each habitat were compared. The logistic regression was used to select risk factors. The clinical, habitat, and hybrid models were constructed using identified risk factors from clinical characteristics, habitat metrics, and their combination, respectively. The diagnostic performance and overall survival (OS) were analyzed.
Results:
Compared with H3 K27-WT tumors, H3 K27-A DMGs had significantly higher f value in habitat 2 and habitat 3, and a larger volume of habitat 3 (all p < 0.05). The age, peritumoral nonenhanced pattern, and habitat metrics were selected as risk factors for constructing diagnostic models. The hybrid model achieved the highest diagnostic performance (area under the curve (AUC) = 0.900), followed by the clinical model (AUC = 0.860) and habitat model (AUC = 0.716). Only the predicted H3 K27-A group by the hybrid model showed significantly different OS compared with the H3 K27-WT group (p = 0.043).
Conclusion:
IVIM-based habitat imaging can noninvasively predict the H3 K27 alteration status of DMG with high accuracy, which is associated with prognosis.
Insights
Intravoxel incoherent motion (IVIM) imaging noninvasively predicts H3 K27 alteration status in diffuse midline gliomas (DMGs). This advanced imaging technique accurately identifies tumor subtypes, aiding in prognosis and treatment decisions.
Area of Science:
- Neuro-oncology
- Medical Imaging
- Molecular Pathology
Background:
- Diffuse midline gliomas (DMGs) are aggressive brain tumors where H3 K27 alteration status is crucial for prognosis and treatment.
- Current methods for determining H3 K27 status require invasive tissue biopsies, posing risks and limitations.
Purpose of the Study:
- To investigate the potential of intravoxel incoherent motion (IVIM) imaging to noninvasively predict the H3 K27 alteration status in DMGs.
- To correlate imaging findings with patient prognosis and overall survival.
Main Methods:
- Retrospective analysis of IVIM MRI data from 153 patients with DMG.
- Classification of DMGs into H3 K27-altered (H3 K27-A) and wild-type (H3 K27-WT) groups.
- Division of tumors into three habitats based on diffusion and perfusion parameters; construction and comparison of clinical, habitat, and hybrid diagnostic models.
Main Results:
- H3 K27-A DMGs exhibited significantly higher perfusion fraction (f) in specific habitats and larger volumes of a high-perfusion habitat compared to H3 K27-WT.
- A hybrid model incorporating clinical and habitat metrics achieved the highest diagnostic performance (AUC = 0.900).
- The hybrid model's predictions of H3 K27-A status were significantly associated with overall survival.
Conclusions:
- IVIM-based habitat imaging offers a noninvasive and accurate method for predicting H3 K27 alteration status in DMGs.
- This approach holds promise for improving prognostic assessment and guiding therapeutic strategies for DMG patients.
