TY - JOUR
T1 - MRI patterns of extrapontine lesion extension in diffuse intrinsic pontine gliomas
AU - Makepeace, L.
AU - Scoggins, M.
AU - Mitrea, B.
AU - Li, Y.
AU - Edwards, A.
AU - Tinkle, C. L.
AU - Hwang, S.
AU - Gajjar, A.
AU - Patay, Z.
N1 - Funding Information:
Disclosures: Lydia Makepeace—RELATED: Grant: National Institutes of Health, National Cancer Institute, Comments: National Institutes of Health Cancer Center Support Grant P30 CA21765, Pediatric Oncology Education grant paid to me; National Cancer Institute grant R25CA23944, institutional grant.* Christopher L. Tinkle—UNRELATED: Payment for Manuscript Preparation: UpToDate, ependymoma chapter. Scott Hwang—UNRELATED: Employment: I am employed as a neuroradiologist; Grants/Grants Pending: National Institutes of Health, Comments: Five percent of my effort is supported by a grant for sickle cell anemia; 9% of my effort is supported by a grant for looking at sleep apnea in Hodgkin lymphoma survivors who received radiation therapy*; Stock/ Stock Options: I have stocks. None of these has any relationship to the research in the article; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: My employer provides a small fund for professional development, which includes travel and room and board for Continuing Medical Education and other academic conferences. None was used for this article. Zoltan Patay—RELATED: Grant: National Institutes of Health, ALSAC, Comments: This work was supported by the National Institutes of Health Cancer Center Support Grant P30 CA21765, the National Cancer Institute grant R25CA23944, and ALSAC*; UNRELATED: Consultancy: Guerbet, Comments: Guerbet Medical Advisory Meeting, Chicago, July 17, 2016, honorarium; Travel/ Accommodations/Meeting Expenses Unrelated to Activities Listed: National Hospital for Neurology and Neurosurgery, University College, London, UK; Radiological Society of Sao Paulo; Hungarian Society of Neuroradiology; Turkish Society of Neuroradiology; European Congress of Magnetic Resonance in Neuropediatrics; European Society of Neuroradiology, Comments: visiting professorship, National Hospital for Neurology and Neurosurgery, University College, London, UK; invited speaker, Radiological Society of Sao Paulo, Brazil; invited speaker, Hungarian Society of Neuroradiology; invited speaker, Turkish Society of Neuroradiology; invited speaker, European Congress of Magnetic Resonance in Neuropediatrics; invited speaker, European Society of Neuroradiology. *Money paid to the institution.
Funding Information:
Received November 1, 2018; accepted after revision December 10, 2019. From the Departments of Diagnostic Imaging (L.M., M.S., B.M., A.E., S.H., Z.P.), Biostatistics (Y.L.), Radiation Oncology (C.L.T.), and Oncology (A.G.), St. Jude Children’s Research Hospital, Memphis, Tennessee. This work was supported by the National Institutes of Health Cancer Center Support Grant P30 CA21765, the National Cancer Institute grant R25CA23944, and American Lebanese Syrian Associated Charities (ALSAC). Please address correspondence to Zoltan Patay, MD, PhD, Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, 262 Danny Thomas Pl, MS220, Memphis, TN 38105-3678; e-mail: [email protected]
Publisher Copyright:
© 2020 American Society of Neuroradiology. All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - BACKGROUND AND PURPOSE: Diffuse intrinsic pontine glioma is a devastating childhood cancer that despite being primarily diagnosed by MR imaging alone, lacks robust prognostic imaging features. This study investigated patterns and quantification of extrapontine lesion extensions as potential prognostic imaging biomarkers for survival in children with newly diagnosed diffuse intrinsic pontine glioma. MATERIALS AND METHODS: Volumetric analysis of baseline MR imaging studies was completed in 131 patients with radiographically defined typical diffuse intrinsic pontine gliomas. Extrapontine tumor extension was classified according to the direction of extension: Midbrain, medulla oblongata, and right and left middle cerebellar peduncles; various extrapontine lesion extension patterns were evaluated. The Kaplan-Meier method was used to estimate survival differences; linear regression was used to evaluate clinical- radiographic variables prognostic of survival. RESULTS: At least 1 extrapontine lesion extension was observed in 125 patients (95.4%). Of the 11 different extrapontine lesion extension patterns encountered in our cohort, 2 were statistically significant predictors of survival. Any extension into the middle cerebellar peduncles was prognostic of shorter overall survival (P=.01), but extension into both the midbrain and medulla oblongata but without extension into either middle cerebellar peduncle was prognostic of longer overall survival compared with those having no extension (P=.04) or those having any other pattern of extension (P<.001). CONCLUSIONS: Within this large cohort of patients with typical diffuse intrinsic pontine gliomas, 2 specific extrapontine lesion extension patterns were associated with a significant overall survival advantage or disadvantage. Our findings may be valuable for risk stratification and radiation therapy planning in future clinical trials.
AB - BACKGROUND AND PURPOSE: Diffuse intrinsic pontine glioma is a devastating childhood cancer that despite being primarily diagnosed by MR imaging alone, lacks robust prognostic imaging features. This study investigated patterns and quantification of extrapontine lesion extensions as potential prognostic imaging biomarkers for survival in children with newly diagnosed diffuse intrinsic pontine glioma. MATERIALS AND METHODS: Volumetric analysis of baseline MR imaging studies was completed in 131 patients with radiographically defined typical diffuse intrinsic pontine gliomas. Extrapontine tumor extension was classified according to the direction of extension: Midbrain, medulla oblongata, and right and left middle cerebellar peduncles; various extrapontine lesion extension patterns were evaluated. The Kaplan-Meier method was used to estimate survival differences; linear regression was used to evaluate clinical- radiographic variables prognostic of survival. RESULTS: At least 1 extrapontine lesion extension was observed in 125 patients (95.4%). Of the 11 different extrapontine lesion extension patterns encountered in our cohort, 2 were statistically significant predictors of survival. Any extension into the middle cerebellar peduncles was prognostic of shorter overall survival (P=.01), but extension into both the midbrain and medulla oblongata but without extension into either middle cerebellar peduncle was prognostic of longer overall survival compared with those having no extension (P=.04) or those having any other pattern of extension (P<.001). CONCLUSIONS: Within this large cohort of patients with typical diffuse intrinsic pontine gliomas, 2 specific extrapontine lesion extension patterns were associated with a significant overall survival advantage or disadvantage. Our findings may be valuable for risk stratification and radiation therapy planning in future clinical trials.
UR - http://www.scopus.com/inward/record.url?scp=85079341811&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85079341811&partnerID=8YFLogxK
U2 - 10.3174/ajnr.a6391
DO - 10.3174/ajnr.a6391
M3 - Article
C2 - 31974084
AN - SCOPUS:85079341811
SN - 0195-6108
VL - 41
SP - 323
EP - 330
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
IS - 2
ER -