"Occult" post-contrast signal enhancement in pediatric diffuse intrinsic pontine glioma is the MRI marker of angiogenesis?

Ashley E. Conway, Wilburn E. Reddick, Yimei Li, Ying Yuan, John O. Glass, Justin N. Baker, Larry E. Kun, Alberto Broniscer, Zoltan Patay

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Introduction: In diffuse intrinsic pontine gliomas (DIPG), subtracting pre-contrast from post-contrast T1-weighted images (T1WI) occasionally reveals subtle, "occult" enhancement. We hypothesized that this represents intravascular enhancement related to angiogenesis and hence that these tumors should have greater blood volume fractions than do non-enhancing tumors. Methods: We retrospectively screened MR images of 66 patients initially diagnosed with DIPG and analyzed pretreatment conventional and dynamic susceptibility contrast (DSC) perfusion MRI studies of 61 patients. To determine the incidence of occult enhancement, cerebral blood volume (CBV) values were compared in areas of occult enhancement (OcE), no enhancement (NE), and normal-appearing deep cerebellar white matter (DCWM). Results: Tumors of 10 patients (16.4 %) had occult enhancement; those of 6 patients (9.8 %) had no enhancement at all. The average CBV in areas of occult enhancement was significantly higher than that in non-enhancing areas of the same tumor (P=.03), within DCWM in the same patient (P=.03), and when compared to anatomically paired/similar regions of interest (ROI) in patients with non-enhancing tumors (P=.005). Conclusion: Areas of OcE correspond to areas of higher CBV in DIPG, which may be an MRI marker for angiogenesis, but larger scale studies may be needed to determine its potential relevance to grading by imaging, treatment stratification, biopsy guidance, and evaluation of response to targeted therapy.

Original languageEnglish (US)
Pages (from-to)405-412
Number of pages8
JournalNeuroradiology
Volume56
Issue number5
DOIs
StatePublished - Jan 1 2014

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Glioma
Pediatrics
Neoplasms
Blood Volume
Perfusion
Biopsy
Incidence
Therapeutics
Cerebral Blood Volume
White Matter

Keywords

  • Angiogenesis
  • Cerebral blood volume
  • Diffuse intrinsic pontine glioma
  • Magnetic resonance imaging
  • Perfusion imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Conway, A. E., Reddick, W. E., Li, Y., Yuan, Y., Glass, J. O., Baker, J. N., ... Patay, Z. (2014). "Occult" post-contrast signal enhancement in pediatric diffuse intrinsic pontine glioma is the MRI marker of angiogenesis? Neuroradiology, 56(5), 405-412. https://doi.org/10.1007/s00234-014-1348-9

"Occult" post-contrast signal enhancement in pediatric diffuse intrinsic pontine glioma is the MRI marker of angiogenesis? / Conway, Ashley E.; Reddick, Wilburn E.; Li, Yimei; Yuan, Ying; Glass, John O.; Baker, Justin N.; Kun, Larry E.; Broniscer, Alberto; Patay, Zoltan.

In: Neuroradiology, Vol. 56, No. 5, 01.01.2014, p. 405-412.

Research output: Contribution to journalArticle

Conway, AE, Reddick, WE, Li, Y, Yuan, Y, Glass, JO, Baker, JN, Kun, LE, Broniscer, A & Patay, Z 2014, '"Occult" post-contrast signal enhancement in pediatric diffuse intrinsic pontine glioma is the MRI marker of angiogenesis?', Neuroradiology, vol. 56, no. 5, pp. 405-412. https://doi.org/10.1007/s00234-014-1348-9
Conway, Ashley E. ; Reddick, Wilburn E. ; Li, Yimei ; Yuan, Ying ; Glass, John O. ; Baker, Justin N. ; Kun, Larry E. ; Broniscer, Alberto ; Patay, Zoltan. / "Occult" post-contrast signal enhancement in pediatric diffuse intrinsic pontine glioma is the MRI marker of angiogenesis?. In: Neuroradiology. 2014 ; Vol. 56, No. 5. pp. 405-412.
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AU - Reddick, Wilburn E.

AU - Li, Yimei

AU - Yuan, Ying

AU - Glass, John O.

AU - Baker, Justin N.

AU - Kun, Larry E.

AU - Broniscer, Alberto

AU - Patay, Zoltan

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N2 - Introduction: In diffuse intrinsic pontine gliomas (DIPG), subtracting pre-contrast from post-contrast T1-weighted images (T1WI) occasionally reveals subtle, "occult" enhancement. We hypothesized that this represents intravascular enhancement related to angiogenesis and hence that these tumors should have greater blood volume fractions than do non-enhancing tumors. Methods: We retrospectively screened MR images of 66 patients initially diagnosed with DIPG and analyzed pretreatment conventional and dynamic susceptibility contrast (DSC) perfusion MRI studies of 61 patients. To determine the incidence of occult enhancement, cerebral blood volume (CBV) values were compared in areas of occult enhancement (OcE), no enhancement (NE), and normal-appearing deep cerebellar white matter (DCWM). Results: Tumors of 10 patients (16.4 %) had occult enhancement; those of 6 patients (9.8 %) had no enhancement at all. The average CBV in areas of occult enhancement was significantly higher than that in non-enhancing areas of the same tumor (P=.03), within DCWM in the same patient (P=.03), and when compared to anatomically paired/similar regions of interest (ROI) in patients with non-enhancing tumors (P=.005). Conclusion: Areas of OcE correspond to areas of higher CBV in DIPG, which may be an MRI marker for angiogenesis, but larger scale studies may be needed to determine its potential relevance to grading by imaging, treatment stratification, biopsy guidance, and evaluation of response to targeted therapy.

AB - Introduction: In diffuse intrinsic pontine gliomas (DIPG), subtracting pre-contrast from post-contrast T1-weighted images (T1WI) occasionally reveals subtle, "occult" enhancement. We hypothesized that this represents intravascular enhancement related to angiogenesis and hence that these tumors should have greater blood volume fractions than do non-enhancing tumors. Methods: We retrospectively screened MR images of 66 patients initially diagnosed with DIPG and analyzed pretreatment conventional and dynamic susceptibility contrast (DSC) perfusion MRI studies of 61 patients. To determine the incidence of occult enhancement, cerebral blood volume (CBV) values were compared in areas of occult enhancement (OcE), no enhancement (NE), and normal-appearing deep cerebellar white matter (DCWM). Results: Tumors of 10 patients (16.4 %) had occult enhancement; those of 6 patients (9.8 %) had no enhancement at all. The average CBV in areas of occult enhancement was significantly higher than that in non-enhancing areas of the same tumor (P=.03), within DCWM in the same patient (P=.03), and when compared to anatomically paired/similar regions of interest (ROI) in patients with non-enhancing tumors (P=.005). Conclusion: Areas of OcE correspond to areas of higher CBV in DIPG, which may be an MRI marker for angiogenesis, but larger scale studies may be needed to determine its potential relevance to grading by imaging, treatment stratification, biopsy guidance, and evaluation of response to targeted therapy.

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