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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Longitudinal analysis of T2-imaging pattern reflects clinical course of astrocytoma

Die longitudinale Analyse des MRI-T2-Verhaltensmusters widerspiegelt den klinischen Verlauf der Astrozytome

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  • presenting/speaker Debora Cipriani - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland
  • Amir El Rahal - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland
  • Pamela Heiland - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland
  • Simon Behringer - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland
  • Nicolas Neidert - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland
  • Mateo Farina Nunez - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland
  • Jürgen Beck - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland
  • Dieter Henrik Heiland - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland
  • Oliver Schnell - Universitätsklinikum Freiburg, Department of Neurosurgery, Freiburg, Deutschland; Universitätsklinikum Freiburg, Translational NeuroOncology Research Group, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV217

doi: 10.3205/21dgnc210, urn:nbn:de:0183-21dgnc2106

Published: June 4, 2021

© 2021 Cipriani et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Therapeutic approaches at recurrence of IDH-mutated astrocytoma still remain unclear. Interpretation of each MRI in follow-up examinations become challenging due to a non-linear growth behavior. Here, we aim to explore growth patterns of IDH-mutated astrocytomas and to predict treatment responses at later stages of the disease.

Methods: Between 2000 and 2018 volumetric diversity of astrocytomas and computed T2-imaging patterns based on segmentation of 7995 follow-up MRI scans of 48 eligible patients diagnosed with IDH-mutated astrocytomas WHO°II and III were analyzed. For tumor segmentation the NORA software tool, a web-based framework for image analysis developed at University of Freiburg has been used. Data analysis was performed by a recently published computational pipeline (by Neurosurgery, University of Freiburg).

Results: The growth patterns of IDH-mutated glioma revealed highly dynamic changes, which were found to be patient-specific and did not directly correlate with clinical parameters or therapeutic interventions. Three major subgroups were identified based on the peak growth maximum at early, middle or late stage of the disease. Frontal tumors were enriched in a subgroup with relatively large tumors at initial diagnosis. Investigations of the optimal timepoint for surgical interventions showed a trend towards a more beneficial effect of resection at initial diagnosis for WHO°III tumors. In WHO°II tumors, no difference between initial surgery or intervention after radio/chemotherapy was found. Surgical resection was found to be beneficial regardless of the WHO grade. In our study an extent of resection above 72.4% of the T2-hyperintense regions was required to show an improvement in overall survival. Multiple resections did not generally improve overall survival, unless greater extent of resection than in previous surgeries was achieved.

Conclusion: Our findings suggest, that in patients suffering from IDH-mutated WHO°II and III astrocytomas show highly dynamic growth behavior that is patient specific (with a large inter-patient variability). In summary, WHO°III IDH-mutated astrocytomas showed improved survival by early surgical intervention while the timepoint of surgical intervention was not crucial for WHO°II tumors. These findings open the possibility for neoadjuvant treatment options at least for IDH-mutated WHO°II astrocytomas in the future