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MRI‐Based Score to Recognize Thalamic Glioma Grade in Children: Morphology, Diffusion, and Arterial‐Spin‐Labeling Perfusion
Author(s) -
Plasse Alexis,
Levy Raphael,
TauzièdeEspariat Arnault,
Agripnidis Thibault,
Hak JeanFrançois,
Roux CharlesJoris,
Samoyeau Thomas,
Ollitrault Alexis,
Beccaria Kevin,
Guida Lelio,
Blauwblomme Thomas,
Grill Jacques,
Dufour Christelle,
GuerriniRousseau Léa,
Bourdeaut Franck,
Doz François,
Varlet Pascale,
Boddaert Nathalie,
DangouloffRos Volodia
Publication year - 2025
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.31704
Subject(s) - medicine , interquartile range , arterial spin labeling , glioma , perfusion , magnetic resonance imaging , cerebral blood flow , nuclear medicine , effective diffusion coefficient , neuroradiology , gastroenterology , radiology , neurology , cancer research , psychiatry
ABSTRACT Purpose Thalamic gliomas are found predominantly in children and can be classified into two main types with different prognoses and management: diffuse midline glioma (DMG) H3K27‐altered and low‐grade glioma (LGG). Our aim was to find imaging features distinguishing these tumors and to develop a diagnostic score. Patients and Methods A retrospective study spanning September 1999 to May 2021 involved pediatric patients with thalamic gliomas, categorized into H3K27‐altered DMG and LGG groups. Preoperative imaging, including morphology, diffusion, and arterial‐spin‐labeling perfusion, was reviewed blindly and compared between the two groups. A diagnostic score was formulated based on significant findings. Results were validated using an internal and external validation cohort. Results Sixty‐six patients were included (median age, 9 years; interquartile range [IQR] [5–13]; 38 girls) with 37 DMG H3K27‐altered and 29 LGG. DMG H3K27‐altered tumors exhibited larger volumes (median 64 cc, IQR [36–88] vs 26 cc, IQR [15–37], p < 0.001), greater heterogeneity in T2‐weighted signal and enhancement (62% [22/37] vs 31% [9/29], p = 0.04, and 97% [32/33] vs 56% [15/27], p = 0.0008, respectively), lower minimum relative apparent diffusion coefficient (ADC) (0.92 (IQR [0.76–1.23]) vs 1.55 (IQR [1.40–1.72]), p < 0.001), and higher relative maximum cerebral blood flow (CBF) levels (2.08 (IQR [1.48–3.05]) vs 0.84 (IQR [0.45–1]), p < 0.001). A diagnostic score integrating tumor diameter, solid content predominance, relative ADC, and relative CBF achieved 100% sensitivity and specificity in distinguishing DMG H3K27‐altered tumors from LGG (full score available for 36 patients), with good results in external and internal validation cohorts (12 patients). Conclusion The morphological, diffusion, and arterial spin labeling imaging characteristics of pediatric thalamic tumors enable excellent differentiation of DMG H3K27‐altered and LGG.