30 Perceived versus quantified growth trajectory of serially-imaged low-grade gliomas

Abstract

Background. Diffuse low-grade gliomas (LGGs) are infiltrative, slow-growing primary brain tumours that remain relatively asymptomatic for long periods of time before transforming into aggressive high-grade gliomas. Surveillance of tumour stability is performed primarily by serial imaging. Methods. We retrospectively identified LGG patients that were managed by observation with numerous (≥8) serial magnetic resonance imaging (MRI) studies. Tumour volumes were measured by manual segmentation on imaging. Demographic information, tumour histopathological data, and radiological interpretations were collected from electronic medical records. MRI radiology reports of tumour volume stability were classified into "growth" and "no growth" interpretations. Results. Of 74 LGG patients, 10 (13.5%) patients were included in the study. A median of 11 MRIs (range, 8-18) over a median of 79.7 months (range, 39.8-113.8 months) were analyzed per patient. Tumour diameter linearly increased at a median rate of 2.17 mm/year. Cox regression analysis showed that initial tumour volume predicted time to clinical intervention, and Mann-Whitney U test found that tumours of patients diagnosed before age 50 grew more slowly. Radiology interpretations that reported "no growth" (n=66) corresponded to a median measured growth of 3.90 mL and 11.0% compared to the comparison scan. Reports of "growth" (n=36) corresponded to median measured volume increases of 9.36 mL and 20.5%. Conclusion. We retrospectively analyzed the natural history of LGGs in serially-imaged patients at a single institution. Comparisons to the literature suggest that this is a subset of particularly slow-growing and low-risk tumours. We also highlight the clinical value of performing accurate LGG volumetric analyses.