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What does enhancement mean in low grade gliomas?

What does enhancement mean in low grade gliomas?. B. Bison, M. Warmuth-Metz, M. Schneckenburger Reference Center for Neuroradiology for the HIT-Studies of the GPOH Departement of Neuroradiology University Hospital Würzburg, Germany. Rationale.

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What does enhancement mean in low grade gliomas?

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  1. What does enhancement mean in low grade gliomas? B. Bison, M. Warmuth-Metz, M. Schneckenburger Reference Center for Neuroradiology for the HIT-Studies of the GPOH Departement of Neuroradiology University Hospital Würzburg, Germany

  2. Rationale • In high grade gliomas an intensification or new contrast enhancement (CE) is considered a sign of malignisation and therefore progression • CE in low grade gliomas is variable and without prognostic significance • Pilocytic astrocytomas showing a spontaneous regression (+/-NF1) always show a reduction of CE

  3. Rationale • New or intensified CE in low grade gliomas is frequently diagnosed as progression by outside (neuro)radiologists in the German patients of the LGG-study.

  4. 6/09 vs. 9/09

  5. Patients • 303 pairs of MRIs of consecutive time points • 73 patients • up to 9 pairs of MRIs per patient • patients with multifocal tumors (n=79) • 3 categories of CE

  6. Change of CE • increase: 35 • no change: 234 • without CE: 75 • decrease: 34

  7. Increase of CE • n = 35 • 9 x size reduction (-39 bis -2%) • 3 x same size • 23 x size increase (2-1664%) • median 14.95% • mean 125.32%

  8. No change of CE • n = 234 • 109 x size reduction (-84 to -0.02%) • 21 x no change of size • 104 x size increase (0.4 to 503.6%) • median 0% • mean 5.8%

  9. Decrease of CE • n = 34 • 12 x size increase (0.2 to 81%) • 22 x size reduction (-2 to -72%) • median -10.4% • mean -14.5%

  10. New enhancement • n = 14 (n=3 no further MRI) • 1 x progression next follow up • 2 x in progression • 1 x in regression • 1 x regression next follow up • 6 x stabile tumor

  11. Conclusion • There is a statistical correlation between CE in low grade gliomas and a change of tumor size. • But, discrepant behaviour can be found in all groups • No conclusion must be drawn from a change of CE alone. • The primary staging criteria is the evolution of tumor size.

  12. Thank you The Reference Center for Neuroradiology for the HIT-studies and the HIT LGG-study are supported by:

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