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MR image phenotypes may add prognostic value to clinical features in IDH wild-type lower-grade gliomas

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Abstract

Purpose

To identify significant prognostic magnetic resonance imaging (MRI) features and their prognostic value when added to clinical features in patients with isocitrate dehydrogenase wild-type (IDHwt) lower-grade gliomas.

Materials and methods

Preoperative MR images of 158 patients (discovery set = 112, external validation set = 46) with IDHwt lower-grade gliomas (WHO grade II or III) were retrospectively analyzed using the Visually Accessible Rembrandt Images feature set. Radiologic risk scores (RRSs) for overall survival were derived from the least absolute shrinkage and selection operator and elastic net. Multivariable Cox regression analysis, including age, Karnofsky Performance score, extent of resection, WHO grade, and RRS, was performed. The added prognostic value of RRS was calculated by comparing the integrated area under the receiver operating characteristic curve (iAUC) between models with and without RRS.

Results

The presence of cysts, pial invasion, and cortical involvement were favorable prognostic factors, while ependymal extension, multifocal or multicentric distribution, nonlobar location, proportion of necrosis > 33%, satellites, and eloquent cortex involvement were significantly associated with worse prognosis. RRS independently predicted survival and significantly enhanced model performance for survival prediction when integrated to clinical features (iAUC increased to 0.773–0.777 from 0.737), which was successfully validated on the validation set (iAUC increased to 0.805–0.830 from 0.735).

Conclusion

MRI features associated with prognosis in patients with IDHwt lower-grade gliomas were identified. RRSs derived from MRI features independently predicted survival and significantly improved performance of survival prediction models when integrated into clinical features.

Key Points

• Comprehensive analysis of MRI features conveys prognostic information in patients with isocitrate dehydrogenase wild-type lower-grade gliomas.

• Presence of cysts, pial invasion, and cortical involvement of the tumor were favorable prognostic factors.

• Radiological phenotypes derived from MRI independently predict survival and have the potential to improve survival prediction when added to clinical features.

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Abbreviations

AIC:

Akaike information criterion

CET:

Enhancing tumor

CI:

Confidence interval

FLAIR:

Fluid-attenuated inversion recovery

FOV:

Field of view

iAUC:

Integrated area under the receiver operating characteristic curve

IDH:

Isocitrate dehydrogenase

IDHwt:

IDH wild-type

KPS:

Karnofsky Performance Status

LASSO:

Least absolute shrinkage and selection operator

LL:

Log likelihood

nCET:

Non-enhancing tumor

OS:

Overall survival

RRS:

Radiologic risk score

T1C:

Contrast-enhanced T1-weighted imaging

TCGA:

The Cancer Genome Atlas

TCIA:

The Cancer Imaging Archive

TE:

Echo time

TR:

Repetition time

VASARI:

Visually Accessible Rembrandt Images

WHO:

World Health Organization

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Funding

This study has received funding from the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, Information and Communication Technologies & Future Planning (2017R1D1A1B03030440).

Author information

Correspondence to Sung Soo Ahn.

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Guarantor

The scientific guarantor of this publication is Sung Soo Ahn.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Kyunghwa Han, Ph.D., from the Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, has significant statistical expertise and is one of the authors.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Park, C.J., Han, K., Shin, H. et al. MR image phenotypes may add prognostic value to clinical features in IDH wild-type lower-grade gliomas. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-06683-2

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Keywords

  • Glioma
  • Isocitrate dehydrogenase
  • Magnetic resonance imaging
  • Prognosis
  • Survival