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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

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Abstract

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 (nADCmax) 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, nADCmax ≥ 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.

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Abbreviations

AIF:

Arterial input function

DMG-A:

Diffuse midline glioma, H3K27-altered

DMG-W:

Midline high-grade glioma without H3K27 alteration

DSC:

Dynamic susceptibility contrast

nADCmax /mean/min :

Normalized maximum/mean/minimum ADC

ncrCBV:

Normalized corrected relative cerebral blood volume

nrCBF:

Normalized relative cerebral blood flow

ROI:

Region-of-interest

WHO:

World Health Organization

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Acknowledgements

The authors thank Ms. Nancy Dudek, an MRI Technologist at University of Michigan Health System, for her technical support. The authors thank Dr. Takeru Q Suyama at National Institute of Informatics, for his advice on statistics.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA

    Ryo Kurokawa, Mariko Kurokawa, Akira Baba, Yoshiaki Ota, John Kim, Aristides Capizzano, Ashok Srinivasan & Toshio Moritani

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  1. Ryo Kurokawa
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Corresponding author

Correspondence to Ryo Kurokawa.

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Guarantor

The scientific guarantor of this publication is Toshio Moritani, Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive Ann Arbor, MI 48109, United States.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Kurokawa, R., Kurokawa, M., Baba, A. et al. 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. Eur Radiol 32, 3672–3682 (2022). https://doi.org/10.1007/s00330-021-08476-7

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