Artikel
Radiographic assessment of contrast enhancement and T2/FLAIR mismatch sign in lower grade gliomas: correlation with molecular groups
Radiologische Bewertung der Kontrastmittelanreicherung und des ,T2/FLAIR mismatch‘-Signals in niedriggradigen Gliomen – eine Korrelation mit den molekularen Gruppen
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Autoren
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Tareq Juratli
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Klinik für Neurochirurgie, Dresden, Deutschland; Massachusetts General Hospital, Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Boston, United States
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Shilpa Tummala
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Klinik für Neurochirurgie, Dresden, Deutschland; Massachusetts General Hospital, Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Boston, United States
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Angelika Riedl
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Klinik für Neurochirurgie, Dresden, Deutschland
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Amir Zolal
- SRH Wald-Klinikum Gera GmbH, Wirbelsäulenchirurgie und Neurotraumatologie, Gera, Deutschland
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Christian Thiede
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Medizinische Klinik I, Dresden, Deutschland
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Gabriele Schackert
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Klinik für Neurochirurgie, Dresden, Deutschland
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Dietmar Krex
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Klinik für Neurochirurgie, Dresden, Deutschland
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Julie Miller
- Massachusetts General Hospital, Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Boston, United States
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Daniel Cahill
- Massachusetts General Hospital, Department of Neurosurgery, Boston, MA, United States
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: With the updated World Health Organization (WHO) 2016 neuropathological diagnostic criteria, radiographic prognostic associations in lower-grade gliomas (LGG, WHO grade II and III) are undergoing re-evaluation.
Methods: We identified 316 LGG patients (151 grade II and 165 grade III) for a combined cohort from three independent databases. We analyzed the preoperative axial FLAIR, axial T2-weighted and post-gadolinium volumetric T1-weighted MR images. The molecular data collected included the status of IDH1/2, TP53, TERT promoter and ATRX mutations, in addition to 1p/19q co-deletions. In a subset of cases (n=133), we assessed the “T2-FLAIR mismatch” sign.
Results: Gliomas were assigned to one of the three molecular groups: Group O (IDH-mutant, 1p/19q co-deleted oligodendrogliomas, n=95), Group A (IDH-mutant, ATRX inactivated astrocytomas, n=175) and Group G (IDH wild-type, GBM-like, n=46). A contrast-enhancing tumor was seen in 98 patients (31%), most frequently in Group G (n=28/45, 57%), when compared to Group A (n=49/175, 28%) and Group O (n=24/95, 25.3%) tumors (p=0.008 and p=0.0011, respectively). Consistent with previous reports, T2-FLAIR mismatch was preferentially found in Group A tumors (73.1%, 60 of 82), although its presence was not associated with survival, after controlling for molecular group. False positive mismatch sign was noted in 28.5% (12/42) Group O tumors, but none of the tumors in Group G. A combination of all three factors: age under 40 years at first diagnosis, a tumor size larger than 6 cm and T2-FLAIR mismatch was highly specific for IDH mutant astrocytoma (Group A).
Conclusion: We identify radiographic correlates of molecular groups in lower-grade gliomas, which join clinical demographic features in defining the characteristic presentation of these tumors. Radiographic correlates of prognosis in LGG require re-evaluation within molecular group.
