Dynamic susceptibility contrast-MRI parameters, ADC values, and the T2-FLAIR mismatch sign are useful to differentiate between H3-mutant and H3-wild-type high-grade midline glioma

• Published in: European radiology Vol. 32; no. 6; pp. 3672 - 3682
• Main Authors: Kurokawa, Ryo, Kurokawa, Mariko, Baba, Akira, Ota, Yoshiaki, Kim, John, Capizzano, Aristides, Srinivasan, Ashok, Moritani, Toshio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2022; Springer Nature B.V
• Subjects: Blood; Blood flow; Blood volume; Brain tumors; Cerebral blood flow; Diagnostic Radiology; Females; Glioma; Imaging; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neuro; Neuroradiology; Parameters; Radiology; Tumors; Ultrasound; Perfusion-weighted magnetic resonance imaging; Diffusion magnetic resonance imaging; Child; Glioblastoma
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-08476-7

Objectives Diffuse midline gliomas, H3K27-altered (DMG-A), are malignant gliomas with an unfavorable prognosis. Knowledge of dynamic susceptibility contrast (DSC) MRI findings and imaging differences with high-grade midline glioma without H3K27 alteration (DMG-W) has been limited. We compared the DSC, ADC, and conventional MRI findings between DMG-A and DMG-W. Methods In this single institutional retrospective study, the electronic database of our hospital between June 2015 and May 2021 was searched. Twenty and 17 patients with DMG-A (median, 13 years; range, 3–52 years; 11 females) and DMG-W (median, 40 years; 7–73 years; 9 females), respectively, were found. Normalized relative cerebral blood flow (nrCBF) and normalized corrected relative cerebral blood volume (ncrCBV); normalized maximum, mean, and minimum ADC values; and the prevalence of T2-FLAIR mismatch sign were compared between the two groups using Mann–Whitney U tests and Fisher’s exact test. Results The nrCBF and ncrCBV were significantly lower in DMG-A compared with DMG-W (nrCBF: median 0.88 [range, 0.19–2.67] vs. 1.47 [range, 0.57–4.90] ( p  < 0.001); ncrCBV: 1.17 [0.20–2.67] vs. 1.56 [0.60–4.03] ( p  = 0.008)). Normalized maximum ADC (nADC max ) was significantly higher in DMG-A (median 2.37 [1.25–3.98] vs. 1.95 [1.23–2.77], p  = 0.02). T2-FLAIR mismatch sign was significantly more common in DMG-A (11/20 (55.0%) vs. 1/17 (5.9%), p  = 0.0017). When at least two of nrCBF < 1.11, nADC max  ≥ 2.48, and T2-FLAIR mismatch sign were positive, the diagnostic performance was the highest with accuracy of 0.81. Conclusion DSC-MRI parameters, ADC values, and the T2-FLAIR mismatch sign are useful to differentiate between DMG-A and DMG-W. Key Points • Diffuse midline glioma, H3K27-altered (DMG-A), showed a significantly lower normalized relative cerebral blood flow and volume compared with H3K27-wild-type counterparts (DMG-W). • T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign was significantly more frequent in DMG-A compared to DMG-W. • Indicators that combined DSC parameters, ADC values, and T2-FLAIR mismatch sign, with or without age, are useful to distinguish the two tumors.