Abstract
ObjectivesTo investigate the value of local image variance (LIV) as a new technique for quantification of hypointense microvascular susceptibility-weighted imaging (SWI) structures at 7 Tesla for preoperative glioma characterization.MethodsAdult patients with neuroradiologically suspected diffusely infiltrating gliomas were prospectively recruited and 7 Tesla SWI was performed in addition to standard imaging. After tumour segmentation, quantification of intratumoural SWI hypointensities was conducted by the SWI-LIV technique. Following surgery, the histopathological tumour grade and isocitrate dehydrogenase 1 (IDH1)-R132H mutational status was determined and SWI-LIV values were compared between low-grade gliomas (LGG) and high-grade gliomas (HGG), IDH1-R132H negative and positive tumours, as well as gliomas with significant and non-significant contrast-enhancement (CE) on MRI.ResultsIn 30 patients, 9 LGG and 21 HGG were diagnosed. The calculation of SWI-LIV values was feasible in all tumours. Significantly higher mean SWI-LIV values were found in HGG compared to LGG (92.7 versus 30.8; p < 0.0001), IDH1-R132H negative compared to IDH1-R132H positive gliomas (109.9 versus 38.3; p < 0.0001) and tumours with significant CE compared to non-significant CE (120.1 versus 39.0; p < 0.0001).ConclusionsOur data indicate that 7 Tesla SWI-LIV might improve preoperative characterization of diffusely infiltrating gliomas and thus optimize patient management by quantification of hypointense microvascular structures.Key Points• 7 Tesla local image variance helps to quantify hypointense susceptibility-weighted imaging structures.• SWI-LIV is significantly increased in high-grade and IDH1-R132H negative gliomas.• SWI-LIV is a promising technique for improved preoperative glioma characterization.• Preoperative management of diffusely infiltrating gliomas will be optimized.
Highlights
Infiltrating gliomas are the most frequent primary brain tumours in adults [1]
Higher mean susceptibility-weighted imaging (SWI)-local image variance (LIV) values were found in high-grade gliomas (HGG) compared to low-grade gliomas (LGG) (92.7 versus 30.8; p < 0.0001), IDH1R132H negative compared to isocitrate dehydrogenase 1 (IDH1)-R132H positive gliomas (109.9 versus 38.3; p < 0.0001) and tumours with significant CE compared to non-significant CE (120.1 versus 39.0; p < 0.0001)
Our data indicate that 7 Tesla SWI-LIV might improve preoperative characterization of diffusely infiltrating gliomas and optimize patient management by quantification of hypointense microvascular structures
Summary
Infiltrating gliomas are the most frequent primary brain tumours in adults [1]. LGG typically show malignant progression to HGG within several years, where the formation of pathological microvessels by neo-angiogenesis represents one of the key steps [2, 6]. The detection of these pathological microvascular structures is crucial for histopathological differentiation of LGG from HGG: while in LGG (WHO grade II) angiogenic features are typically absent, glioblastoma multiforme (GBM; WHO grade IV), the most common and malignant form of glioma, is characterized by the presence of pathognomonic microvascular proliferates [2, 6]. To different microvascular patterns in gliomas of various grades of malignancy, neo-angiogenesis, and formation of pathological microvessels was found to be associated with IDH1/2 mutational status with increased neoangiogenesis in IDH1/2 wild-type gliomas and inhibition of neo-angiogenesis in IDH1/2 mutant tumours [14]. Reliable identification of these pathological microvascular structures is essential for preoperative glioma characterization to plan the appropriate surgical strategy and postoperative therapy, as well as assessment of the individual patient prognosis
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