Abstract
Background: Malignant high-grade gliomas are characterized by infiltration and destruction of surrounding brain tissue. Alterations in the contrahemispheric brain structure and their roles that may offer prognostically valuable information have not been investigated in high-grade gliomas.Methods: In total, 153 patients with unilateral glioma (low-grade, n = 77; high-grade, n = 76) and 115 healthy controls (HCs) were recruited and scanned with 3-D T1 imaging. The gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) volume in the contrahemisphere were examined. Partial correlation, logistic regression, and multivariate Cox's regression analyses were performed.Results: The contrahemispheric GM volume (CHGMV) in the high-grade glioma patients was significantly decreased compared to that in the HCs/low-grade gliomas (one-way ANOVA, Bonferroni corrected, p < 0.05). The CHGMV is significantly correlated with the WHO grade (r = −0.22, p < 0.05) and contrast-enhanced volume (r = −0.33, p < 0.01). In the high-grade gliomas, the binary logistic regression revealed that the CHGMV can independently predict isocitrate dehydrogenase 1 (IDH1) and P53 mutations. The survival curves revealed that the patients with a low CHGMV had a shorter overall survival (OS) than the patients with a high CHGMV (p = 0.001). The multivariate Cox's regression analysis showed that a low CHGMV can independently predict unfavorable OS with a hazard ratio of 2.883 (p = 0.035).Conclusions: Volume of the contrahemispheric cortex can be potentially used in clinical practice as an imaging biomarker to predict survival and molecular markers in patients with unilateral high-grade gliomas.
Highlights
Malignant high-grade gliomas (WHO grade III and IV) are the most common primary brain cancers in adults and have a dismal prognosis despite the use of microsurgical resection, followed by chemotherapy and radiotherapy [1,2,3]
Considering that the extent of the tumor burden on contrahemispheric cortex might offer prognostically valuable information, we further explored the possibility of using the contrahemispheric brain structure extracted from T1 images to predict survival and molecular markers in patients with highgrade gliomas
In the high-grade glioma group (n = 76), all patients received standard-of-care treatment, including surgical resection followed by radiation therapy and concurrent and adjuvant temozolomide except for six patients who were lost to followup
Summary
Malignant high-grade gliomas (WHO grade III and IV) are the most common primary brain cancers in adults and have a dismal prognosis despite the use of microsurgical resection, followed by chemotherapy and radiotherapy [1,2,3]. High-grade gliomas are characterized by diffuse infiltration and the destruction of surrounding brain tissue, even invasive remote brain regions along white matter (WM) tracts [4]. The imaging, pathologic, and molecular features of malignant glioma provide opportunities for subclassification, prognostication, and the development of targeted therapies [3, 5,6,7,8]. The development of a quantitative assessment using advanced magnetic resonance techniques, including diffusion, perfusion, spectroscopy, tractography, and structural and functional MRI, could enable accurate, non-invasive investigation of the brain structure and function alterations and aid in designing treatment plans, assessing tumor malignancy and molecular status, and predicting prognosis in patients with glioma [7, 10,11,12]. Malignant high-grade gliomas are characterized by infiltration and destruction of surrounding brain tissue. Alterations in the contrahemispheric brain structure and their roles that may offer prognostically valuable information have not been investigated in high-grade gliomas
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