Diffusion-weighted imaging-gadolinium enhancement mismatch sign in diffuse midline glioma

• Published in: European journal of radiology 2022-02, Vol.147, p.110103-110103, Article 110103
• Main Authors: Ikeda, Koki, Kolakshyapati, Manish, Takayasu, Takeshi, Amatya, Vishwa Jeet, Takano, Motoki, Yonezawa, Ushio, Taguchi, Akira, Onishi, Shumpei, Takeshima, Yukio, Sugiyama, Kazuhiko, Yamasaki, Fumiyuki
• Format: Article
• Language: English
• Subjects: Contrast Media; Gadolinium; Glioma - diagnostic imaging; Humans; Mutation; Retrospective Studies
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2021.110103

•DWI-Gd mismatch sign is observed in some of diffuse midline glioma including diffuse intrinsic pontine glioma.•Existence of high intensity on DWI and gadolinium enhancement were the significant poor prognostic markers in DMG.•Positive DWI-Gd mismatch sign is the strongest poor prognostic marker in DMG. Diffuse midline glioma (DMG), H3 K27M-mutant including diffuse intrinsic pontine glioma (DIPG) is a disease with dismal prognosis. We focused on diffusion-weighted imaging (DWI) and gadolinium enhanced T1WI (Gd), especially high intensity on DWI at non-enhanced lesion, i.e. DWI-Gd mismatch sign, to establish as an imaging biomarker of DMG patients. Our institutional review board approved this retrospective study. Twenty-one patients diagnosed as DMG including DIPG at our institution between 2007 and 2020 were enrolled in this study. All patients underwent local radiotherapy of 54 Gy/30 fractions. We studied the relationship between imaging features including DWI-Gd mismatch sign and prognosis. DWI-Gd mismatch sign was found in 9 out of 21 DMG patients. Among different imaging characteristics, existence of high intensity on DWI (P = 0.0014), gadolinium enhancement (P = 0.00071) were the significant poor prognostic markers in DMG, which were consistent with the previous reports about DIPG. In our results, positive DWI-Gd mismatch sign was statistically strongest poor prognostic imaging biomarker, and patients with positive DWI-Gd mismatch sign had shorter OS compared to those with negative mismatch sign (9.9 months vs 18.6 months, P = 0.00062). DWI/Gd mismatch sign and intratumoral bleeding were more common in DMG at thalamus compared to DMG at pons/DIPG (P = 0.046 and P = 0.0017, respectively). DWI-Gd mismatch sign may be an imaging biomarker for poor prognosis in DMG. (E-1601)