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Qualitative MR features to identify non-enhancing tumors within glioblastoma’s T2-FLAIR hyperintense lesions

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Abstract

Purpose

To identify qualitative MRI features of non-(contrast)-enhancing tumor (nCET) in glioblastoma’s T2-FLAIR hyperintense lesion.

Methods

Thirty-three histologically confirmed glioblastoma patients whose T1-, T2- and contrast-enhanced T1-weighted MRI and 11C-methionine positron emission tomography (Met-PET) were available were included in this study. Met-PET was utilized as a surrogate for tumor burden. Imaging features for identifying nCET were searched by qualitative examination of 156 targets. A new scoring system to identify nCET was established and validated by two independent observers.

Results

Three imaging features were found helpful for identifying nCET; “Bulky gray matter involvement”, “Around the rim of contrast-enhancement (Around-rim),” and “High-intensity on T1WI and low-intensity on T2WI (HighT1LowT2)” resulting in an nCET score = 2 × Bulky gray matter involvement – 2 × Around-rim + HighT1LowT2 + 2. The nCET score’s classification performances of two independent observers measured by AUC were 0.78 and 0.80, with sensitivities and specificities using a threshold of four being 0.443 and 0.771, and 0.916 and 0.768, respectively. The weighted kappa coefficient for the nCET score was 0.946.

Conclusion

The current investigation demonstrated that qualitative assessments of glioblastoma’s MRI might help identify nCET in T2/FLAIR high-intensity lesions. The novel nCET score is expected to aid in expanding treatment targets within the T2/FLAIR high-intensity lesions.

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Data availability

The data generated and analyzed during the current study are not publicly available for legal/ethical reasons but are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Osaka Greneral Medical Center, Bandai-higashi 3-1-56, Sumiyoshi-ku, Osaka, 558-8558, Japan

    Shota Yamamoto

  2. Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan

    Shota Yamamoto, Yoshiko Okita, Naoki Kagawa & Haruhiko Kishima

  3. Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Hideyuki Arita

  4. Department of Neurosurgery, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan

    Shota Yamamoto, Takahiro Sanada & Manabu Kinoshita

  5. Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Mio Sakai & Katsuyuki Nakanishi

  6. Department of Diagnostic Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan

    Atsuko Arisawa

  7. Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan

    Eku Shimosegawa

Authors
  1. Shota Yamamoto
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Contributions

M.S., A.A., N.K., E.S., and K.N. acquired data. S.Y., Y.O., H.A., T.S., and M.K. analyzed the data. H.K. supervised the research project. M.K conceptualized the research. All authors reviewed the manuscript.

Corresponding author

Correspondence to Manabu Kinoshita.

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Yamamoto, S., Okita, Y., Arita, H. et al. Qualitative MR features to identify non-enhancing tumors within glioblastoma’s T2-FLAIR hyperintense lesions. J Neurooncol 165, 251–259 (2023). https://doi.org/10.1007/s11060-023-04454-9

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  • DOI: https://doi.org/10.1007/s11060-023-04454-9

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