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First published on August 12, 2008
A more recent version of this article appeared on January 1, 2009
Neuro Oncol 2008, DOI:10.1215/15228517-2008-066
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© Copyright 2008 by the Society for Neuro-Oncology

Received December 19, 2007
Accepted April 18, 2008

Clinical Investigations

Prognostic Significance of Imaging Contrast Enhancement for WHO grade II Gliomas

Johan Pallud 1*, Laurent Capelle 2, Luc Taillandier 3, Denys Fontaine 4, Emmanuel Mandonnet 2, Rémy Guillevin 5, Luc Bauchet 6, Philippe Peruzzi 7, Florence Laigle-Donadey 8, Michčle Kujas 9, Jacques Guyotat 10, Marie-Hélčne Baron 11, Karima Mokhtari 12, Hugues Duffau 13

1 Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France; Réseau d’Etude des Gliomes, REG, France
2 Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France; INSERM U678, 75013 Paris, France; Réseau d’Etude des Gliomes, REG, France
3 Service de Neuro-Oncologie, Hôpital neurologique de Nancy, 54000 Nancy, France; Réseau d’Etude des Gliomes, REG, France
4 Service de Neurochirurgie, CHU de Nice, 06000 Nice, France; Réseau d’Etude des Gliomes, REG, France
5 Service de Neuro-Radiologie, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France; Réseau d’Etude des Gliomes, REG, France
6 Service de Neurochirurgie, CHU de Montpellier, 34000 Montpellier, France; Réseau d’Etude des Gliomes, REG, France
7 Service de Neurochirurgie, CHU de Reims, 51100 Reims, France; Réseau d’Etude des Gliomes, REG, France
8 Service de Neuropathologie Mazarin, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France; Réseau d’Etude des Gliomes, REG, France
9 Service de Neuro-Pathologie, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France; Réseau d’Etude des Gliomes, REG, France; Réseau d’Etude des Gliomes, REG, France
10 Service de Neurochirurgie, CHU de Lyon, 69500 Bron, France; Réseau d’Etude des Gliomes, REG, France
11 Service de Radiothérapie, CHU de Besançon, Besançon, France; Réseau d’Etude des Gliomes, REG, France
12 Service de Neuro-Pathologie, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France; Réseau d’Etude des Gliomes, REG, France
13 ; INSERM U678, 75013 Paris, France; Service de Neurochirurgie, CHU de Montpellier, 34000 Montpellier, France; Réseau d’Etude des Gliomes, REG, France

* To whom correspondence should be addressed. E-mail: johanpallud{at}hotmail.com.


  Abstract

The purpose of the present study was to investigate the prognostic value of magnetic resonance imaging contrast enhancement (CE) at the time of histological diagnosis specifically in a selected population of World Health Organization (WHO) Grade II gliomas. A total of 927 histologically proven WHO grade II gliomas were reviewed, for which contrast-enhanced magnetic resonance imaging was available at the time of histological diagnosis. Contrast enhancement patterns were classified into three categories: “patchy and faint”, “nodular-like” and “ring-like”. Contrast enhancement progression over time was recorded before oncological treatment on successive MRIs, when available. Contrast enhancement was present in 143 cases (15.9%), with 93 “patchy and faint”, 50 “nodular-like” and no “ring-like” patterns. Contrast enhancement areas were time progressive before oncological treatment in 35 of the 56 available cases (62.5%). Regardless of its pattern, the presence of contrast enhancement was not significantly associated with a worsened prognosis (p=0.415) by univariate analysis. Only the “nodular-like” pattern of contrast enhancement (p<0.01) and the time progressive contrast enhancements (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 the contrast enhancement at the time of histological diagnosis and, whenever possible, to follow its progression over time before oncological treatment. Indeed, “nodular-like” contrast enhancements and time progressive contrast enhancements are associated with a worsened prognosis, both suggesting malignant transformation, eventhough histopathological examination can not initially disclose signs of malignancy in those areas.

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


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Copyright 2008 by Society for Neuro-Oncology