Looking through the imaging perspective: the importance of imaging necrosis in glioma diagnosis and prognostic prediction – single centre experience

Hui Ma; Shanmei Zeng; Dingxiang Xie; Wenting Zeng; Yingqian Huang; Liwei Mazu; Nengjin Zhu; Zhiyun Yang; Jianping Chu; Jing Zhao

doi:10.2478/raon-2024-0014

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Looking through the imaging perspective: the importance of imaging necrosis in glioma diagnosis and prognostic prediction – single centre experience

Radiology and Oncology

Volume 58 (2024): Issue 1 (March 2024)

By: Hui Ma, Shanmei Zeng, Dingxiang Xie, Wenting Zeng, Yingqian Huang, Liwei Mazu, Nengjin Zhu, Zhiyun Yang, Jianping Chu and Jing Zhao

Open Access

|Feb 2024

Figures & Tables

Representative ROI delineations. A 53-year-old man was diagnosed with glioblastoma, IDH-wildtype. **(A)** contrastenhanced T1-weighted image (T1WI-CE); **(B)** the time-signal intensity curve; **(C)** the transfer constant (*ktrans*) image; **(D)** rate constant (*kep*) image; **(E)** extravascular extracellular volume fraction (ve) image; **(F)** initial area under the curve in the first 60 s (*iauc*) image. On images, B-F, ROI 1 marked green represented tumor parenchyma, ROI 2 marked yellow represented the peripheral zones, and ROI 3 marked blue-turquoise represented contralateral normal-appearing brain tissues.

Representative MR images with imaging necrosis derived from a 53-year-old man with glioblastoma, IDH-wildtype. Shown from left to right by the order are T1WI **(A)**, T2WI **(B)**, and T1WI-CE **(C)**.

TABLE 1.

Participant demographic findings

Negative n (%)	Positive n (%)
Age (n = 150)	-	40.54±11.08 (n = 54)	50.39±12.47 (n = 96)	-	−4.829&	p < 0.001
Sex (n = 150)	male	36(66.67)	68(70.83)	104	0.282	0.595
female	18(33.33)	28(29.17)	46
IDH (n = 144)	wildtype	17(32.08)	69(75.82)	86	26.649	p < 0.001
mutant	36(67.92)	22(24.18)	58
1p19q (n = 109)	non-codeletion	23(51.11)	55(85.94)	78	15.746	p < 0.001
codeletion	22(48.89)	9(14.06)	31
CDKN2A/B homozygous deletion (n = 63)	non-deletion	38(100.00)	20(80.00)	58	5.745b	0.017*
deletion	0(0.00)	5(20.00)	5
EGFR amplification (n = 81)	non-amplification	8(66.67)	45(65.22)	53	0.054a	0.817
amplification	4(33.33)	24(34.78)	28
chr7 gain/10 loss (n = 26)	negative	10(83.33)	13(92.86)	23	0.552b	0.457
positive	2(16.67)	1(7.14)	3
Grade (n = 119)	high-grade	6(16.22)	70(85.37)	76	52.828	p < 0.001
low-grade	31(83.78)	12(14.63)	43
WHO grade (n = 119)	WHO grade 2	26(70.27)	4(4.88)	30	62.664a	p < 0.001
WHO grade (n = 119)	WHO grade 3	5(13.51)	8(9.76)	13	62.664a	p < 0.001
WHO grade 4	6(16.22)	70(85.37)	76
Integrated histo-molecular diagnoses (n = 116)	Oligodendroglioma, IDH-mutant and 1p/19q-deleted	17(45.95)	7(8.86)	24	41.238	p < 0.001
Integrated histo-molecular diagnoses (n = 116)	Astrocytoma, IDH-mutant	15(40.54)	12(15.19)	27	41.238	p < 0.001
Glioblastoma, IDH-wildtype	5(13.51)	60(75.95)	65

{ label (or @symbol) needed for fn[@id='j_raon-2024-0014_table-fn_001'] } & = Student's t statistic in this cell, and other cells in the same column represent Chi-square values. a and b = chi-square tests with continuity correction and Fisher's exact tests, respectively;

* = p < 0.05

TABLE 2.

Detailed clinical, imaging and pathological information of Only Im_necrosis group and Only Pa_necrosis group

Group	Grade	Sex	Age	OS (month)	IDH (0:wild; 1:mutant)	1p19q (0:non-codeletion; 1:codeletion)	CDKN2A/B (0:non-deletion; 1:deletion)	EGFR amplification (0:non-amplification; 1:amplification)	chr7 gain/10 loss (0:negative; 1:positive)	Pathology
Only Pa_necrosis group	WHO CNS grade 4	female	63	2.5	1	0	0	NA	NA	Astrocytoma, IDH-mutant
Only Pa_necrosis group	CNS WHO grade 4	female	55	20	0	0	NA	0	NA	Glioblastoma, IDH-wildtype
Only Pa_necrosis group	CNS WHO grade 2	female	36	NA	1	1	0	NA	NA	Oligodendroglioma, IDH-mutant and 1p/19q-deleted
Only Pa_necrosis group	NA	female	34	NA	1	NA	NA	NA	NA	IDH-mutation, NOS
Only Im_necrosis group	CNS WHO grade 4	male	64	5	0	0	NA	1	NA	Glioblastoma, IDH-wildtype
Only Im_necrosis group	CNS WHO grade 2	male	40	25	1	0	0	NA	NA	Astrocytoma, IDH-mutant
Only Im_necrosis group	CNS WHO grade 3	female	55	60.06	1	1	0	NA	NA	Oligodendroglioma, IDH-mutant and 1p/19q-deleted
Only Im_necrosis group	CNS WHO grade 2	male	26	5.39	1	0	0	0	0	Astrocytoma, IDH-mutant
Only Im_necrosis group	NQ	male	40	7.19	0	0	NA	0	NA	IDH-wildtype, NOS
Only Im_necrosis group	NA	male	28	19.68	0	0	NA	0	0	IDH-wildtype, NOS
Only Im_necrosis group	CNS WHO grade 3	male	26	34.42	1	0	0	NA	NA	Astrocytoma, IDH-mutant

Some representative MRI images without imaging necrosis which was exactly confused in diagnosing imaging necrosis. Shown from left to right by the order are T1WI, T2WI, and T1WI-CE. **(A)** a 24-year-old man with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2; **(B)** a 39-year-old man with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2; **(C)** a 55-year-old woman with an oligodendroglioma, IDHmutant and 1p/19q-deleted, CNS WHO grade 2; **(D)** a 45-year-old man with an astrocytoma, CNS IDH-mutant, WHO grade 2; **(E)** a 36-year-old woman with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2. In this case **(E)**, it showed multiple long tubular and filiform enhancement and there were some tumor areas with remarked decrease of reinforcement. But these areas are hyperintense, not hypointense, on the T1-weighted image. Comparing with CT images (not provided), calcification on these areas were just observed. So, there was no imaging necrosis in these conditions.

Survival curves for cases of imaging necrosis **(A)**, cases of pathological necrosis **(B),** and cases of both pathological and imaging necrosis **(C)**.

TABLE 3.

Representative results of non-parametric tests and ROC analyses between DCE-related data for gliomas with or without pathological necrosis/imaging necrosis

Parameter	p	AUC (95% CI)	Sensitivity	Specificity	Cut-off
Pa_necrosis
Tumor-ktrans-Mean	< 0.001	0.824 (0.711 ~0.936)	0.94	0.625	0.07
Edema-ktrans-Mean	0.031*	0.655 (0.527 ~ 0.783)	0.833	0.46	0.03
Tumor-ve-Mean	< 0.001	0.891 (0.788 ~ 0.995)	0.96	0.833	0.17
Edema-ve-Mean	0.002**	0.728 (0.613 ~ 0.842)	0.34	1	0.16
Tumor-kep-Mean	< 0.001	0.872 (0.761 ~ 0.983)	0.833	0.86	2.48
Tumor-iauc-Mean	< 0.001	0.899 (0.803 ~ 0.996)	1	0.75	0.07
Im_necrosis
Tumor-ktrans-Mean	< 0.001	0.856 (0.772 ~ 0.939)	0.877	0.757	0.08
Tumor-ve-Mean	< 0.001	0.929 (0.872 ~ 0.986)	0.892	0.919	0.17
Edema-ve-Mean	0.005**	0.667 (0.558 ~ 0.776)	0.708	0.595	0.06
Tumor-kep-Mean	< 0.001	0.914 (0.857 ~ 0.971)	0.946	0.831	2.74
Tumor-iauc-Mean	< 0.001	0.909 (0.844 ~ 0.974)	0.8	0.946	0.13

* = p < 0.05;

** = p < 0.01

Articles in this issue

DOI: https://doi.org/10.2478/raon-2024-0014 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 23 - 32

Submitted on: Sep 19, 2023

Accepted on: Dec 1, 2023

Published on: Feb 21, 2024

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

glioma,

MRI,

Related subjects:

© 2024 Hui Ma, Shanmei Zeng, Dingxiang Xie, Wenting Zeng, Yingqian Huang, Liwei Mazu, Nengjin Zhu, Zhiyun Yang, Jianping Chu, Jing Zhao, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 58 (2024): Issue 1 (March 2024)

Looking through the imaging perspective: the importance of imaging necrosis in glioma diagnosis and prognostic prediction – single centre experience

Figures & Tables

FIGURE 1.

FIGURE 2.

TABLE 1.

TABLE 2.

FIGURE 3.

FIGURE 4.

TABLE 3.

Paradigm

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