Can conventional magnetic resonance imaging predict survival in pediatric diffuse intrinsic pontine glioma? A single institution experience

BackgroundPediatric diffuse intrinsic pontine glioma (DIPG) remains dismal regardless the new therapeutic and technical advances.ObjectiveTo investigate the value of magnetic resonance imaging (MRI) in predicting DIPG prognosis.Patients and methodsTwenty-five DIPG patients with 95 (initial and post radiotherapy) MR examinations were studied. Hydrocephalus was detected in 6 cases (24%), basilar artery encasement in 20 (80%), ill defined border in 16 (64%), perilesional edema in 2 cases (8%) and none showed leptomeningeal spread. Conformal 3-dimensional radiotherapy (39 Gy/13 fractions or 54 Gy/30 fractions) was applied.ResultsThe median overall survival (MOS) was 9.3 months (95% CI: 7.9–10.8) and the one year overall survival was 18 ± 8.9%. Post radiation MRI performed 3–6 months after treatment showed regression in 8 cases (32%), stationary course in 5 (20%) and progression in 12 cases (48%). The MOS was higher in children whose MRI showed regression (10.0, CI: 6.3–13.7) than those with radiological progression (8.0, CI: 5.9–10.1 months) or stationary course (7.0, CI: 4.9–9.1). However; these differences did not rank to the level of significance. There was no statistical association of tumor size (p = 0.907), presence of hemorrhage (p = 0.314), or surrounding edema (p = 0.263); entrapment of the basilar artery (p = 0.782); pattern of enhancement (p = 0.851); and hydrocephalus (p = 0.354) with the length of the overall survival.ConclusionsThough MRI is the mainstay for the diagnosis of DIPG, yet its prognostic value is limited. New MR techniques as MR spectroscopy and diffusion tensor imaging should be evaluated as additional tools for prognostic evaluation of DIPG.