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“Occult” post-contrast signal enhancement in pediatric diffuse intrinsic pontine glioma is the MRI marker of angiogenesis?

  • Paediatric Neuroradiology
  • Published:
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Abstract

Introduction

In diffuse intrinsic pontine gliomas (DIPG), subtracting pre-contrast from post-contrast T1-weighted images (T1WI) occasionally reveals subtle, “occult” enhancement. We hypothesized that this represents intravascular enhancement related to angiogenesis and hence that these tumors should have greater blood volume fractions than do non-enhancing tumors.

Methods

We retrospectively screened MR images of 66 patients initially diagnosed with DIPG and analyzed pretreatment conventional and dynamic susceptibility contrast (DSC) perfusion MRI studies of 61 patients. To determine the incidence of occult enhancement, cerebral blood volume (CBV) values were compared in areas of occult enhancement (OcE), no enhancement (NE), and normal-appearing deep cerebellar white matter (DCWM).

Results

Tumors of 10 patients (16.4 %) had occult enhancement; those of 6 patients (9.8 %) had no enhancement at all. The average CBV in areas of occult enhancement was significantly higher than that in non-enhancing areas of the same tumor (P = .03), within DCWM in the same patient (P = .03), and when compared to anatomically paired/similar regions of interest (ROI) in patients with non-enhancing tumors (P = .005).

Conclusion

Areas of OcE correspond to areas of higher CBV in DIPG, which may be an MRI marker for angiogenesis, but larger scale studies may be needed to determine its potential relevance to grading by imaging, treatment stratification, biopsy guidance, and evaluation of response to targeted therapy.

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Acknowledgments

The authors thank Suzanne Gronemeyer, PhD, and the St. Jude Pediatric Oncology Education Program for supporting this work, Angela Edwards for post processing of some of the perfusion data and Cherise M. Guess, PhD, ELS, of St. Jude Children’s Research Hospital’s Scientific Editing Department for reviewing and editing the manuscript. This work was supported in part by Cancer Center Support (CORE) Grant (P30 CA21765) and 5R25CA02394 (to AEC) from the National Cancer Institute and the American Lebanese Syrian Associated Charities (ALSAC).

Conflict of interest

AB received partial financial support from AstraZeneca to conduct a clinical trial related to some of the patients included in the research described in this manuscript.

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Authors and Affiliations

  1. Department of Radiological Sciences, St. Jude Children’s Research Hospital, MS220, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Ashley E. Conway, Wilburn E. Reddick, Yimei Li, Ying Yuan, John O. Glass, Justin N. Baker, Larry E. Kun, Alberto Broniscer & Zoltan Patay

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  1. Ashley E. Conway
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  2. Wilburn E. Reddick
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Correspondence to Zoltan Patay.

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Conway, A.E., Reddick, W.E., Li, Y. et al. “Occult” post-contrast signal enhancement in pediatric diffuse intrinsic pontine glioma is the MRI marker of angiogenesis?. Neuroradiology 56, 405–412 (2014). https://doi.org/10.1007/s00234-014-1348-9

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  • DOI: https://doi.org/10.1007/s00234-014-1348-9

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