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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Insular lower-grade gliomas behave differently – a volumetric MRI and neuropathological retrospective analysis

Das Verhalten von niedriggradigen Inselgliomen unterscheidet sich von anderen Tumoren – eine MRT-Volumetriestudie unter Einbeziehung neuropathologischer molekularer Marker

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  • presenting/speaker Christian F. Freyschlag - Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Austria
  • Aleksandrs Krigers - Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Austria
  • Mathias Demetz - Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Austria
  • Johannes Kerschbaumer - Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Austria
  • Claudius Thomé - Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP180

doi: 10.3205/20dgnc464, urn:nbn:de:0183-20dgnc4645

Published: June 26, 2020

© 2020 Freyschlag et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The location of lower-grade gliomas [c1] (LGG) showed a preference for eloquent regions within the brain, especially involving the insula. With the constant development of MR imaging and the diagnostic prioritisation of molecular markers plus the increased detection of anaplastic foci within LGG, therapeutic strategies need to be tailored. The aim of our study was to correlate tumour volumetry and imaging parameters of insular tumours with the WHO grades, presence of anaplastic foci and molecular markers.

Methods: From our database we could identify 99 consecutive patients with histologically proven lower-grade gliomas, 13 (13%) of which were exclusively insular tumours. All underwent their first resection in our institution. The volume on MRI was measured in T1 CE and native, T2, FLAIR and DWI sequences. Molecular markers, neuropathological, epidemiological and clinical data were analysed in correlation to the non-insular cohort.

Results: There were no significant differences in preoperative tumour volumes in MRI T1, T2, FLAIR and DWI sequences as well as considering contrast enhancement compared to tumours with different localization. However, the remnant volume of the insular tumours in postoperative MRI was significantly larger in T1 Sequences – median 26.7 cm3 (IqR 9.2 ÷ 53.3) vs. 44.8 cm3 (IqR 15.5 ÷ 83.0), p=0.048; and tended to be larger in T2 and DWI.Five [c1] patients with insular LGG with progressiove disease showed minor relative growth from their last MRI compared to tumours in other localizations: in T1 – median 67% (IqR 17 ÷ 251) vs. 3% (IqR -26 ÷ 16), p=0.006; in T2 – 35% (IqR 20 ÷ 71) vs. 6% (IqR -22 ÷ 14), p=0.004; in FLAIR Sequence – 33% (IqR 16 ÷ 68) vs. 4% (IqR -25 ÷ 16), p=0.004. We could not find any significant differences considering preoperative symptoms, epidemiological data, WHO Grade, ATRX or IDH1 Status, PFS and OS.

Conclusion: Extent of resection in insular gliomas is worse than in more superficial tumours, however, growth rates upon recurrence/regrowth seem to be lower than in frontal or temporal tumours.