Journal of Neuro-Oncology

, Volume 117, Issue 1, pp 175–182 | Cite as

Diffusion-weighted MRI derived apparent diffusion coefficient identifies prognostically distinct subgroups of pediatric diffuse intrinsic pontine glioma

  • Robert M. Lober
  • Yoon-Jae Cho
  • Yujie Tang
  • Patrick D. Barnes
  • Michael S. Edwards
  • Hannes Vogel
  • Paul G. Fisher
  • Michelle Monje
  • Kristen W. Yeom
Clinical Study


While pediatric diffuse intrinsic pontine gliomas (DIPG) remain fatal, recent data have shown subgroups with distinct molecular biology and clinical behavior. We hypothesized that diffusion-weighted MRI can be used as a prognostic marker to stratify DIPG subsets with distinct clinical behavior. Apparent diffusion coefficient (ADC) values derived from diffusion-weighted MRI were computed in 20 consecutive children with treatment-naïve DIPG tumors. The median ADC for the cohort was used to stratify the tumors into low and high ADC groups. Survival, gender, therapy, and potential steroid effects were compared between the ADC groups. Median age at diagnosis was 6.6 (range 2.3–13.2) years, with median follow-up seven (range 1–36) months. There were 14 boys and six girls. Seventeen patients received radiotherapy, five received chemotherapy, and six underwent cerebrospinal fluid diversion. The median ADC of 1,295 × 10−6 mm2/s for the cohort partitioned tumors into low or high diffusion groups, which had distinct median survivals of 3 and 13 months, respectively (log-rank p < 0.001). Low ADC tumors were found only in boys, whereas high ADC tumors were found in both boys and girls. Available tissue specimens in three low ADC tumors demonstrated high-grade histology, whereas one high ADC tumor demonstrated low-grade histology with a histone H3.1 K27M mutation and high-grade metastatic lesion at autopsy. ADC derived from diffusion-weighted MRI may identify prognostically distinct subgroups of pediatric DIPG.


Diffuse intrinsic pontine glioma (DIPG) Diffusion Diffusion-weighted imaging (DWI) Apparent diffusion coefficient (ADC) MRI 



The authors express our sincere gratitude to Dr. Terri Haddix for her assistance in histologic preparations and photography of specimens.

Conflict of interest

There are no conflicts of interest or funding source to disclose.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Robert M. Lober
    • 1
  • Yoon-Jae Cho
    • 2
  • Yujie Tang
    • 2
  • Patrick D. Barnes
    • 3
  • Michael S. Edwards
    • 1
  • Hannes Vogel
    • 4
  • Paul G. Fisher
    • 2
  • Michelle Monje
    • 5
  • Kristen W. Yeom
    • 3
  1. 1.Department of Neurosurgery, Lucile Packard Children’s HospitalStanford UniversityPalo AltoUSA
  2. 2.Department of Neurology, Lucile Packard Children’s HospitalStanford UniversityPalo AltoUSA
  3. 3.Department of Radiology, Lucile Packard Children’s HospitalStanford UniversityPalo AltoUSA
  4. 4.Department of Pathology, Lucile Packard Children’s HospitalStanford UniversityPalo AltoUSA
  5. 5.Department of Neurology, Lucile Packard Children’s HospitalStanford UniversityStanfordUSA

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