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Glioblastomas with and without peritumoral fluid-attenuated inversion recovery (FLAIR) hyperintensity present morphological and microstructural differences on conventional MR images

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Abstract

Objectives

Glioblastoma (GB) without peritumoral fluid-attenuated inversion recovery (FLAIR) hyperintensity is atypical and its characteristics are barely known. The aim of this study was to explore the differences in pathological and MRI-based intrinsic features (including morphologic and first-order features) between GBs with peritumoral FLAIR hyperintensity (PFH-bearing GBs) and GBs without peritumoral FLAIR hyperintensity (PFH-free GBs).

Methods

In total, 155 patients with pathologically diagnosed GBs were retrospectively collected, which included 110 PFH-bearing GBs and 45 PFH-free GBs. The pathological and imaging data were collected. The Visually AcceSAble Rembrandt Images (VASARI) features were carefully evaluated. The first-order radiomics features from the tumor region were extracted from FLAIR, apparent diffusion coefficient (ADC), and T1CE (T1-contrast enhanced) images. All parameters were compared between the two groups of GBs.

Results

The pathological data showed more alpha thalassemia/mental retardation syndrome X-linked (ATRX)-loss in PFH-free GBs compared to PFH-bearing ones (p < 0.001). Based on VASARI evaluation, PFH-free GBs had larger intra-tumoral enhancing proportion and smaller necrotic proportion (both, p < 0.001), more common non-enhancing tumor (p < 0.001), mild/minimal enhancement (p = 0.003), expansive T1/FLAIR ratio (p < 0.001) and solid enhancement (p = 0.009), and less pial invasion (p = 0.010). Moreover, multiple ADC- and T1CE-based first-order radiomics features demonstrated differences, especially the lower intensity heterogeneity in PFH-free GBs (for all, adjusted p < 0.05).

Conclusions

Compared to PFH-bearing GBs, PFH-free ones demonstrated less immature neovascularization and lower intra-tumoral heterogeneity, which would be helpful in clinical treatment stratification.

Clinical relevance statement

Glioblastomas without peritumoral FLAIR hyperintensity show less immature neovascularization and lower heterogeneity leading to potential higher treatment benefits due to less drug resistance and treatment failure.

Key Points

• The study explored the differences between glioblastomas with and without peritumoral FLAIR hyperintensity.

• Glioblastomas without peritumoral FLAIR hyperintensity showed less necrosis and contrast enhancement and lower intensity heterogeneity.

• Glioblastomas without peritumoral FLAIR hyperintensity had less immature neovascularization and lower tumor heterogeneity.

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Abbreviations

ADC:

Apparent diffusion coefficient

ATRX:

Alpha thalassemia/mental retardation syndrome X-linked

ECM:

Extracellular matrix

FDR:

False discovery rate

FLAIR:

Fluid-attenuated inversion recovery

GB:

Glioblastoma

ICC:

Intraclass correlation coefficient

MAD:

Mean absolute deviation

nCET:

Non-contrast enhancing tumor

PFH:

Peritumoral FLAIR hyperintensity

rMAD:

Robust mean absolute deviation

ROC:

Receiver operator characteristics

SNR:

Signal-to-noise ratio

T1CE:

T1-contrast enhanced

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

VASARI:

Visually AcceSAble Rembrandt Images

VEGF:

Vascular endothelial growth factor

VOI:

Volume of interest

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Acknowledgments

We thank all authors who contributed to the present study.

Funding

This project was supported by Shanghai Municipal Science and Technology Major Project (No. 2018SHZDZX01) and ZJ Lab, Shanghai Center for Brain-Inspired Technology, Medical Engineering Fund of Fudan University (yg2021-029), Shanghai Sailing Program (Grant No. 21YF1404800), Youth Program of Special Project for Clinical Research of Shanghai Municipal Health Commission Health industry (Grant No. 20204Y0423) and Youth Medical Talents –Medical Imaging Practitioner Program (No.3030256001).

Author information

Author notes

  1. Qiuyue Han, Yi** Lu, and Dongdong Wang contributed equally to this work and should be regarded as co-first authors.

  2. Bo Yin and Daoying Geng contributed equally and should be regarded as co-corresponding authors.

Authors and Affiliations

  1. Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Rd. Middle, 200040, Shanghai, China

    Qiuyue Han, Yi** Lu, Dongdong Wang, Xuanxuan Li, Zhuoying Ruan, Nan Mei, Daoying Geng & Bo Yin

  2. Shanghai Institute of Medical Imaging, Shanghai, China

    Qiuyue Han

  3. Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China

    **ong Ji

  4. Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Shanghai, China

    Daoying Geng

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Correspondence to Daoying Geng or Bo Yin.

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The scientific guarantor of this publication is Bo Yin.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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This was a retrospective study and informed consent was waived from all subjects.

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This retrospective study was approved by the local ethics committee.

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• case-control study

• performed at one institution

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Han, Q., Lu, Y., Wang, D. et al. Glioblastomas with and without peritumoral fluid-attenuated inversion recovery (FLAIR) hyperintensity present morphological and microstructural differences on conventional MR images. Eur Radiol 33, 9139–9151 (2023). https://doi.org/10.1007/s00330-023-09924-2

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