<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3><p>The aim of the study was to investigate the diagnostic value of imaging necrosis (Im<sub>necrosis</sub>) in grading, predict the genotype and prognosis of gliomas, and further assess tumor necrosis by dynamic contrast-enhanced MR perfusion imaging (DCE-MRI).</p></sec>
<sec><h3>Patients and methods</h3><p>We retrospectively included 150 patients (104 males, mean age: 46 years old) pathologically proved as adult diffuse gliomas and all diagnosis was based on the 2021 WHO central nervous system (CNS) classification. The pathological necrosis (Pa<sub>necrosis</sub>) and gene mutation information were collected. All patients underwent conventional and DCE-MRI examinations and had been followed until May 31, 2021. The Im<sub>necrosis</sub> was determined by two experienced neuroradiologists. DCE-MRI derived metric maps have been post-processed, and the mean value of each metric in the tumor parenchyma, peritumoral and contralateral area were recorded.</p></sec>
<sec><h3>Results</h3><p>There was a strong degree of inter-observer agreement in defining Im<sub>necrosis</sub> (Kappa = 0.668, p &lt; 0.001) and a strong degree of agreement between Im<sub>necrosis</sub> and Pa<sub>necrosis</sub> (Kappa = 0.767, p &lt; 0.001). Compared to low-grade gliomas, high-grade gliomas had more Im<sub>necrosis</sub> (85.37%, p &lt; 0.001), and Im<sub>necrosis</sub> significantly increased with the grade of gliomas increasing. And Im<sub>necrosis</sub> was significantly more identified in <italic>IDH</italic>-wildtype, <italic>1p19q</italic>-non-codeletion, and <italic>CDKN2A/B</italic>-homozygous-deletion gliomas. Using multivariate Cox regression analysis, Im<sub>necrosis</sub> was an independent and unfavorable prognosis factor (Hazard Ratio = 2.113, p = 0.046) in gliomas. Additionally, extravascular extracellular volume fraction (<italic>ve</italic>) in tumor parenchyma derived from DCE-MRI demonstrated the highest diagnostic efficiency in identifying Pa<sub>necrosis</sub> and Im<sub>necrosis</sub> with high specificity (83.3% and 91.9%, respectively).</p></sec>
<sec><h3>Conclusions</h3><p>Im<sub>necrosis</sub> can provide supplementary evidence beyond Pa<sub>necrosis</sub> in grading, predicting the genotype and prognosis of gliomas, and <italic>ve</italic> in tumor parenchyma can help to predict tumor necrosis with high specificity.</p></sec>
</abstract>

BackgroundThe aim of the study was to investigate the diagnostic value of imaging necrosis (Imnecrosis) in grading, predict the genotype and prognosis of gliomas, and further assess tumor necrosis by dynamic contrast-enhanced MR perfusion imaging (DCE-MRI).
Patients and methodsWe retrospectively included 150 patients (104 males, mean age: 46 years old) pathologically proved as adult diffuse gliomas and all diagnosis was based on the 2021 WHO central nervous system (CNS) classification. The pathological necrosis (Panecrosis) and gene mutation information were collected. All patients underwent conventional and DCE-MRI examinations and had been followed until May 31, 2021. The Imnecrosis was determined by two experienced neuroradiologists. DCE-MRI derived metric maps have been post-processed, and the mean value of each metric in the tumor parenchyma, peritumoral and contralateral area were recorded.
ResultsThere was a strong degree of inter-observer agreement in defining Imnecrosis (Kappa = 0.668, p < 0.001) and a strong degree of agreement between Imnecrosis and Panecrosis (Kappa = 0.767, p < 0.001). Compared to low-grade gliomas, high-grade gliomas had more Imnecrosis (85.37%, p < 0.001), and Imnecrosis significantly increased with the grade of gliomas increasing. And Imnecrosis was significantly more identified in IDH-wildtype, 1p19q-non-codeletion, and CDKN2A/B-homozygous-deletion gliomas. Using multivariate Cox regression analysis, Imnecrosis was an independent and unfavorable prognosis factor (Hazard Ratio = 2.113, p = 0.046) in gliomas. Additionally, extravascular extracellular volume fraction (ve) in tumor parenchyma derived from DCE-MRI demonstrated the highest diagnostic efficiency in identifying Panecrosis and Imnecrosis with high specificity (83.3% and 91.9%, respectively).
ConclusionsImnecrosis can provide supplementary evidence beyond Panecrosis in grading, predicting the genotype and prognosis of gliomas, and ve in tumor parenchyma can help to predict tumor necrosis with high specificity.

Looking through the imaging perspective: the importance of imaging necrosis in glioma diagnosis and prognostic prediction – single centre experience

Department of Radiology, The First Affiliated Hospital

Radiology and Oncology

This work is licensed under the Creative Commons Attribution 4.0 International License.

BackgroundThe aim of the study was to investigate the diagnostic value of imaging necrosis (Imnecrosis) in grading, predict the genotype and prognosis of...

Looking through the imaging perspective: the importance of imaging necrosis in glioma diagnosis and prognostic prediction – single centre experience

Article Category: Research Article

Published Online: Feb 21, 2024

Page range: 23 - 32

Received: Sep 19, 2023

Accepted: Dec 01, 2023

DOI: https://doi.org/10.2478/raon-2024-0014

Keywords
glioma, necrosis, MRI, molecular markers, prognosis

© 2024 Hui Ma et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Looking through the imaging perspective: the importance of imaging necrosis in glioma diagnosis and prognostic prediction – single centre experience

Article Category: Research Article

Published Online: Feb 21, 2024

Page range: 23 - 32

Received: Sep 19, 2023

Accepted: Dec 01, 2023

DOI: https://doi.org/10.2478/raon-2024-0014

Keywordsglioma, necrosis, MRI, molecular markers, prognosis

© 2024 Hui Ma et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
glioma, necrosis, MRI, molecular markers, prognosis