The diagnostic value of contrast enhancement on MRI in diffuse and anaplastic gliomas

• Published in: Acta neurochirurgica 2022-08, Vol.164 (8), p.2035-2040
• Main Authors: Krigers, Aleksandrs, Demetz, Matthias, Grams, Astrid E., Thomé, Claudius, Freyschlag, Christian F.
• Format: Article
• Language: English
• Subjects: Age; Gadolinium; Glioma; Image processing; Interventional Radiology; Magnetic resonance imaging; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Nervous system; Neurology; Neuropathology; Neuroradiology; Neurosurgery; Normal distribution; Original Article - Tumor - Glioma; Segmentation; Surgical Orthopedics; Tumor – Glioma; Tumors
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-021-05103-8

Purpose We evaluated differentiations in gadolinium contrast enhancement (CE) between low-grade WHO °II and high-grade WHO °III gliomas in conventional MRI, which have been repeatedly questioned. Methods Ninety-nine patients, who underwent first resection of WHO°II and °III gliomas, were retrospectively retrieved from a prospective database. The quantitative metric volume of Gd-CE in T1-weighted pre-operative MRI was measured using volumetric segmentation. Results The OR to detect CE in anaplastic gliomas was seven times higher than that in diffuse gliomas (CI95% 2.8–17.2,  p< 0.0001). No CE was seen in 50% (8/16) of focal anaplastic and in 28% (10/36) of entirely anaplastic gliomas. CE was present in 21% (10/47) of diffuse gliomas. Anaplasia correlated with a larger CE volume ( r= 0.49, p< 0.0001) and provided additional 4 cm 3  of CE volume compared to entirely diffuse tumors. The OR to have CE was 3.6 times for IDH1 wild-type tumors (CI95% 1.3–10.2, p= 0.05) and 4.8 for tumors with ATRX expression (CI95% 1.3–17.2,  p= 0.05). In all sub-groups, at least a quarter of cases showed no CE at all and there were cases with present CE. Conclusion CE is associated with higher odds of unfavorable prognostic features like anaplasia, wild-type IDH1 and retained ATRX. There was no CE in one-fourth of anaplastic gliomas and half of gliomas with focal anaplasia.