Diffusion Characteristics of Pediatric Diffuse Midline Gliomas with Histone H3-K27M Mutation Using Apparent Diffusion Coefficient Histogram Analysis

• Type of Material: Article
• Authors: M. S. Aboian, Yale University; E. Tong, Stanford University; D. A. Solomon, University of California San Francisco; C. Kline, University of California San Francisco; A. Gautam, Johns Hopkins University; A. Vardapetyan, University of California Berkeley; B. Tamrazi, Childrens Hospital Los Angeles; Y. Li, University of California San Francisco; C. D. Jordan, University of California San Francisco; E. Felton, University of California San Francisco; Brent Weinberg, Emory University; S. Braunstein, University of California San Francisco; S. Mueller, University of California San Francisco; S. Cha, University of California San Francisco
• Language: English
• Date: 2019-11-01
• Publisher: Stryker
• Publication Version: Final Published Version
• Copyright Statement: © 2019 by the American Society of Neuroradiology.
• Final Published Version (URL): http://dx.doi.org/10.3174/ajnr.A6302
• Title of Journal or Parent Work: American Journal of Neuroradiology
• Volume: 40
• Issue: 11
• Start Page: 1804
• End Page: 1810
• Grant/Funding Information: Elizabeth Tong was funded by National Institutes of Health T32 Grant 5T32EB001631-12.; Cassie Kline was funded by National Institutes of Health National Center for Advancing Translational Sciences University of California, San Francisco–Clinical and Translational Science Grant KL2TR000143.; David A. Solomon is funded by the NIH Director's Early Independence Award from the National Institutes of Health, Office of the Director (DP5 OD021403).; Mariam Aboian was funded by American Society of Neuroradiology Fellow Award 2018 and the National Institutes of Health T32 Grant 5T32EB001631-12.
• Keywords: Neuroimaging; Neurosciences & Neurology; Classification; Radiology, Nuclear Medicine & Medical Imaging; Metrics; Life Sciences & Biomedicine; Science & Technology; Tumors; Clinical Neurology; H3F3A; Subgroups
• Research Categories: Health Sciences, Radiology; Biology, Neuroscience; Health Sciences, Oncology

Abstract

BACKGROUND AND PURPOSE: Diffuse midline gliomas with histone H3 K27M mutation are biologically aggressive tumors with poor prognosis defined as a new diagnostic entity in the 2016 World Health Organization Classification of Tumors of the Central Nervous System. There are no qualitative imaging differences (enhancement, border, or central necrosis) between histone H3 wildtype and H3 K27M-mutant diffuse midline gliomas. Herein, we evaluated the utility of diffusion-weighted imaging to distinguish H3 K27M-mutant from histone H3 wildtype diffuse midline gliomas. MATERIALS AND METHODS: We identified 31 pediatric patients (younger than 21 years of age) with diffuse gliomas centered in midline structures that had undergone assessment for histone H3 K27M mutation. We measured ADC within these tumors using a voxel-based 3D whole-tumor measurement method. RESULTS: Our cohort included 18 infratentorial and 13 supratentorial diffuse gliomas centered in midline structures. Twenty-three (74%) tumors carried H3-K27M mutations. There was no difference in ADC histogram parameters (mean, median, minimum, maximum, percentiles) between mutant and wild-type tumors. Subgroup analysis based on tumor location also did not identify a difference in histogram descriptive statistics. Patients who survived,1 year after diagnosis had lower median ADC (1.10 × 10⁻3mm2/s; 95% CI, 0.90-1.30) compared with patients who survived .1 year (1.46 × 10⁻3mm2/s; 95% CI, 1.19-1.67; P, .06). Average ADC values for diffuse midline gliomas were 1.28 × 10⁻3mm2/s (95% CI, 1.21-1.34) and 0.86 × 10⁻3mm2/s (95% CI, 0.69-1.01) for hemispheric glioblastomas with P, .05. CONCLUSIONS: Although no statistically significant difference in diffusion characteristics was found between H3-K27M mutant and H3 wildtype diffuse midline gliomas, lower diffusivity corresponds to a lower survival rate at 1 year after diagnosis. These findings can have an impact on the anticipated clinical course for this patient population and offer providers and families guidance on clinical outcomes.