Diffusion-weighted imaging-gadolinium enhancement mismatch sign in diffuse midline glioma

Koki Ikeda; Manish Kolakshyapati; Takeshi Takayasu; Vishwa Jeet Amatya; Motoki Takano; Ushio Yonezawa; Akira Taguchi; Shumpei Onishi; Yukio Takeshima; Kazuhiko Sugiyama; Fumiyuki Yamasaki

doi:10.1016/j.ejrad.2021.110103

Diffusion-weighted imaging-gadolinium enhancement mismatch sign in diffuse midline glioma

Eur J Radiol. 2022 Feb:147:110103. doi: 10.1016/j.ejrad.2021.110103. Epub 2021 Dec 13.

Authors

Affiliations

¹ Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, National Hospital Organization, Higashihiroshima Medical Center, Hiroshima, Japan.
² Department of Neuroscience, B&B Hospital, Gwarko, Lalitpur, Nepal.
³ Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁴ Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁵ Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan.
⁶ Department of Clinical Oncology and Neuro-oncology Program, Hiroshima University Hospital, Hiroshima, Japan.
⁷ Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: fyama@hiroshima-u.ac.jp.

PMID: 35051691
DOI: 10.1016/j.ejrad.2021.110103

Abstract

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).

MeSH terms

Contrast Media
Gadolinium*
Glioma* / diagnostic imaging
Humans
Mutation
Retrospective Studies

Substances

Contrast Media
Gadolinium