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Prognostic significance of imaging contrast enhancement for WHO grade II gliomas

Réseau d'Etude des Gliomes, Groland (J.P., L.C., L.T., D.F., E.M., R.G., L.B., P.P., F.L.-D., M.K., J.G., M.-H.B., K.M., H.D.), Department of Neurosurgery (J.P., L.C., E.M.), Neuro-Radiology (R.G.), Neuropathology Mazarin (F.L.-D.), and Neuropathology (M.K., K.M.), Hôpital de la Pitié-Salpêtrière, Paris; INSERM U678, Paris (L.C., E.M., H.D.); Department of Neuro-Oncology, Hôpital Neurologique de Nancy, Nancy (L.T.); Department of Neurosurgery, Centre Hospitalier Universitaire de Nice, Nice (D.F.); Department of Neurosurgery, Centre Hospitalier Universitaire de Montpellier, Montpellier (L.B., H.D.); Department of Neurosurgery, Centre Hospitalier Universitaire de Reims, Reims (P.P.); Department of Neurosurgery, Centre Hospitalier Universitaire de Lyon, Bron (J.G.); Department of Radiotherapy, Centre Hospitalier Universitaire de Besançon, Besançon (M.-H.B.); France

Address correspondence to Laurent Capelle, Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France (laurent.capelle{at}psl.ap-hop-paris.fr).

In this study, we investigated the prognostic value of MRI contrast enhancement (CE) at the time of histological diagnosis specifically in a selected population of WHO grade II gliomas. We reviewed 927 histologically proven WHO grade II gliomas for which contrast-enhanced MR images were available at the time of histological diagnosis. CE patterns were classified into three categories: "patchy and faint," "nodular-like," and "ring-like." CE progression over time was recorded before oncological treatment on successive MR images, when available. CE was present in 143 cases (15.9%), with 93 patchy and faint, 50 nodular-like, and no ring-like patterns. CE areas were time progressive before oncological treatment in 35 of the 56 available cases (62.5%). Regardless of its pattern, the presence of CE was not significantly associated with a worsened prognosis (p = 0.415) by univariate analysis. Only the nodular-like pattern of CE (p < 0.01) and the time-progressive CE (p < 0.001) in the available subgroup proved to be statistically associated with survival since first oncological treatment. The present results show the necessity, in cases of WHO grade II gliomas, to study CE at the time of histological diagnosis and, whenever possible, to follow its progression over time before oncological treatment. Nodular-like CE and time-progressive CE are associated with a worsened prognosis, both suggesting malignant transformation, even though histopathological examination cannot initially disclose signs of malignancy in those areas.

Key Words: contrast enhancement • histology • magnetic resonance imaging • prognosis • WHO grade II glioma

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