ArticleNeuroradiology2025
Histopathological grades as prognostic factors of H3 K27-altered diffuse midline glioma and their prediction using multiparametric MR imaging.
Article in Neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundH3K27-altered diffuse midline gliomas (H3K27-altered DMGs) are classified as WHO grade 4 tumors despite their histopathological characteristics. However, histopathological grades are known to have an important effect on prognosis. This study aims to investigate the prognostic impact of histopathological grades on H3K27-altered DMGs and to predict the grades using multiparametric MRI.
methodsWe conducted a retrospective study on H3K27-altered DMG patients diagnosed between December 2016 and February 2023. Tumors were classified as histologically lower- or high-grade DMGs by experienced pathologists. The influence of histopathological grades on prognosis was analyzed by Kaplan-Meier curve and Cox regression. Propensity score matching minimized baseline bias. Clinical and multimodal MRI variables were analyzed through age-stratified subgroup analysis. Logistic regression model was constructed for grade prediction and evaluated using the C-index and F1 score.
results90 (53 lower-grade, 37 high-grade) had survival data and 44 (26 lower-grade, 18 high-grade) had complete multiparametric MRI data. Lower-grade patients exhibited significantly longer median overall survival than high-grade (10.5 months vs. 4 months, p < 0.05). Histopathological grade was confirmed as an independent prognostic factor. Qualitative MR imaging features revealed that high-grade DMGs in juveniles showed significantly larger enhancement quality and edema proportion (p < 0.05). Quantitative perfusion parameters like relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV) differed significantly between high- and lower-grade groups in both juveniles and adults (p < 0.05). rCBF_99th, enhancement quality, and edema proportion, selected from variables with intergroup differences, formed a nomogram model with a C-index of 0.8596, AUC of 0.885 (0.833 validation), and F1 score of 0.8648.
conclusionsHistological grades could not be ignored when assessing the prognosis of H3K27-altered DMGs. Multimodal MR imaging signatures may play an important role in the prediction of histological grades and thus contribute to a layered risk management of DMGs.
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