Open Access

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

Hui Ma
Hui Ma
, 
Shanmei Zeng
Shanmei Zeng
, 
Dingxiang Xie
Dingxiang Xie
, 
Wenting Zeng
Wenting Zeng
, 
Yingqian Huang
Yingqian Huang
, 
Liwei Mazu
Liwei Mazu
, 
Nengjin Zhu
Nengjin Zhu
, 
Zhiyun Yang
Zhiyun Yang
, 
Jianping Chu
Jianping Chu
 and 
Jing Zhao
Jing Zhao
   | Feb 21, 2024
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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
© 2024 Hui Ma et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Representative ROI delineations. A 53-year-old man was diagnosed with glioblastoma, IDH-wildtype. (A) contrastenhanced T1-weighted image (T1WI-CE); (B) the time-signal intensity curve; (C) the transfer constant (ktrans) image; (D) rate constant (kep) image; (E) extravascular extracellular volume fraction (ve) image; (F) initial area under the curve in the first 60 s (iauc) image. On images, B-F, ROI 1 marked green represented tumor parenchyma, ROI 2 marked yellow represented the peripheral zones, and ROI 3 marked blue-turquoise represented contralateral normal-appearing brain tissues.
Representative ROI delineations. A 53-year-old man was diagnosed with glioblastoma, IDH-wildtype. (A) contrastenhanced T1-weighted image (T1WI-CE); (B) the time-signal intensity curve; (C) the transfer constant (ktrans) image; (D) rate constant (kep) image; (E) extravascular extracellular volume fraction (ve) image; (F) initial area under the curve in the first 60 s (iauc) image. On images, B-F, ROI 1 marked green represented tumor parenchyma, ROI 2 marked yellow represented the peripheral zones, and ROI 3 marked blue-turquoise represented contralateral normal-appearing brain tissues.

FIGURE 2.

Representative MR images with imaging necrosis derived from a 53-year-old man with glioblastoma, IDH-wildtype. Shown from left to right by the order are T1WI (A), T2WI (B), and T1WI-CE (C).
Representative MR images with imaging necrosis derived from a 53-year-old man with glioblastoma, IDH-wildtype. Shown from left to right by the order are T1WI (A), T2WI (B), and T1WI-CE (C).

FIGURE 3.

Some representative MRI images without imaging necrosis which was exactly confused in diagnosing imaging necrosis. Shown from left to right by the order are T1WI, T2WI, and T1WI-CE. (A) a 24-year-old man with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2; (B) a 39-year-old man with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2; (C) a 55-year-old woman with an oligodendroglioma, IDHmutant and 1p/19q-deleted, CNS WHO grade 2; (D) a 45-year-old man with an astrocytoma, CNS IDH-mutant, WHO grade 2; (E) a 36-year-old woman with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2. In this case (E), it showed multiple long tubular and filiform enhancement and there were some tumor areas with remarked decrease of reinforcement. But these areas are hyperintense, not hypointense, on the T1-weighted image. Comparing with CT images (not provided), calcification on these areas were just observed. So, there was no imaging necrosis in these conditions.
Some representative MRI images without imaging necrosis which was exactly confused in diagnosing imaging necrosis. Shown from left to right by the order are T1WI, T2WI, and T1WI-CE. (A) a 24-year-old man with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2; (B) a 39-year-old man with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2; (C) a 55-year-old woman with an oligodendroglioma, IDHmutant and 1p/19q-deleted, CNS WHO grade 2; (D) a 45-year-old man with an astrocytoma, CNS IDH-mutant, WHO grade 2; (E) a 36-year-old woman with an oligodendroglioma, IDH-mutant and 1p/19q-deleted, CNS WHO grade 2. In this case (E), it showed multiple long tubular and filiform enhancement and there were some tumor areas with remarked decrease of reinforcement. But these areas are hyperintense, not hypointense, on the T1-weighted image. Comparing with CT images (not provided), calcification on these areas were just observed. So, there was no imaging necrosis in these conditions.

FIGURE 4.

Survival curves for cases of imaging necrosis (A), cases of pathological necrosis (B), and cases of both pathological and imaging necrosis (C).
Survival curves for cases of imaging necrosis (A), cases of pathological necrosis (B), and cases of both pathological and imaging necrosis (C).

Participant demographic findings

Parameters Type Imaging necrosis
 Sum t/χ2b p
Negative n (%) Positive n (%)
Age (n = 150) - 40.54±11.08 (n = 54) 50.39±12.47 (n = 96) - −4.829& p < 0.001
Sex (n = 150) male 36(66.67) 68(70.83) 104 0.282 0.595
female 18(33.33) 28(29.17) 46
IDH (n = 144) wildtype 17(32.08) 69(75.82) 86 26.649 p < 0.001
mutant 36(67.92) 22(24.18) 58
1p19q (n = 109) non-codeletion 23(51.11) 55(85.94) 78 15.746 p < 0.001
codeletion 22(48.89) 9(14.06) 31
CDKN2A/B homozygous deletion (n = 63) non-deletion 38(100.00) 20(80.00) 58 5.745b 0.017*
deletion 0(0.00) 5(20.00) 5
EGFR amplification (n = 81) non-amplification 8(66.67) 45(65.22) 53 0.054a 0.817
amplification 4(33.33) 24(34.78) 28
chr7 gain/10 loss (n = 26) negative 10(83.33) 13(92.86) 23 0.552b 0.457
positive 2(16.67) 1(7.14) 3
Grade (n = 119) high-grade 6(16.22) 70(85.37) 76 52.828 p < 0.001
low-grade 31(83.78) 12(14.63) 43
WHO grade (n = 119) WHO grade 2 26(70.27) 4(4.88) 30 62.664a p < 0.001
WHO grade 3 5(13.51) 8(9.76) 13
WHO grade 4 6(16.22) 70(85.37) 76
Integrated histo-molecular diagnoses (n = 116) Oligodendroglioma, IDH-mutant and 1p/19q-deleted 17(45.95) 7(8.86) 24 41.238 p < 0.001
Astrocytoma, IDH-mutant 15(40.54) 12(15.19) 27
Glioblastoma, IDH-wildtype 5(13.51) 60(75.95) 65

Representative results of non-parametric tests and ROC analyses between DCE-related data for gliomas with or without pathological necrosis/imaging necrosis

Parameter p AUC (95% CI) Sensitivity Specificity Cut-off
Panecrosis
Tumor-ktrans-Mean < 0.001 0.824 (0.711 ~0.936) 0.94 0.625 0.07
Edema-ktrans-Mean 0.031* 0.655 (0.527 ~ 0.783) 0.833 0.46 0.03
Tumor-ve-Mean < 0.001 0.891 (0.788 ~ 0.995) 0.96 0.833 0.17
Edema-ve-Mean 0.002** 0.728 (0.613 ~ 0.842) 0.34 1 0.16
Tumor-kep-Mean < 0.001 0.872 (0.761 ~ 0.983) 0.833 0.86 2.48
Tumor-iauc-Mean < 0.001 0.899 (0.803 ~ 0.996) 1 0.75 0.07
Imnecrosis
Tumor-ktrans-Mean < 0.001 0.856 (0.772 ~ 0.939) 0.877 0.757 0.08
Tumor-ve-Mean < 0.001 0.929 (0.872 ~ 0.986) 0.892 0.919 0.17
Edema-ve-Mean 0.005** 0.667 (0.558 ~ 0.776) 0.708 0.595 0.06
Tumor-kep-Mean < 0.001 0.914 (0.857 ~ 0.971) 0.946 0.831 2.74
Tumor-iauc-Mean < 0.001 0.909 (0.844 ~ 0.974) 0.8 0.946 0.13

Detailed clinical, imaging and pathological information of Only Imnecrosis group and Only Panecrosis group

Group Grade Sex Age OS (month) IDH (0:wild; 1:mutant) 1p19q (0:non-codeletion; 1:codeletion) CDKN2A/B (0:non-deletion; 1:deletion) EGFR amplification (0:non-amplification; 1:amplification) chr7 gain/10 loss (0:negative; 1:positive) Pathology
Only Panecrosis group WHO CNS grade 4 female 63 2.5 1 0 0 NA NA Astrocytoma, IDH-mutant
Only Panecrosis group CNS WHO grade 4 female 55 20 0 0 NA 0 NA Glioblastoma, IDH-wildtype
Only Panecrosis group CNS WHO grade 2 female 36 NA 1 1 0 NA NA Oligodendroglioma, IDH-mutant and 1p/19q-deleted
Only Panecrosis group NA female 34 NA 1 NA NA NA NA IDH-mutation, NOS
Only Imnecrosis group CNS WHO grade 4 male 64 5 0 0 NA 1 NA Glioblastoma, IDH-wildtype
Only Imnecrosis group CNS WHO grade 2 male 40 25 1 0 0 NA NA Astrocytoma, IDH-mutant
Only Imnecrosis group CNS WHO grade 3 female 55 60.06 1 1 0 NA NA Oligodendroglioma, IDH-mutant and 1p/19q-deleted
Only Imnecrosis group CNS WHO grade 2 male 26 5.39 1 0 0 0 0 Astrocytoma, IDH-mutant
Only Imnecrosis group NQ male 40 7.19 0 0 NA 0 NA IDH-wildtype, NOS
Only Imnecrosis group NA male 28 19.68 0 0 NA 0 0 IDH-wildtype, NOS
Only Imnecrosis group CNS WHO grade 3 male 26 34.42 1 0 0 NA NA Astrocytoma, IDH-mutant
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