MRI Patterns of Extrapontine Lesion Extension in Diffuse Intrinsic Pontine Gliomas

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FIG 1.
Vertical extrapontine lesion extensions in a patient with DIPG on sagittal postcontrast T1WI (A and C) and T2WI FLAIR (B and D) scans. Segmented (A and B) lesion extensions into the midbrain and medulla oblongata are highlighted in red and blue, respectively.
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FIG 2.
Unilateral horizontal extrapontine lesion extension in a patient with DIPG in transverse postcontrast T1WI (A and C) and T2WI (B and D). The segmented (A and B) extrapontine lesion extension toward the right middle cerebellar peduncle is highlighted in yellow.
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FIG 3.
Kaplan-Meier plot of OS of the cohort. Any extension (Ext) into the middle cerebellar peduncles was prognostic of shorter overall survival (P = .01).
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FIG 4.
Frequency of patterns of extrapontine lesion extension. M indicates midbrain; MO, medulla oblongata; L.MCP indicates left middle cerebellar peduncle; R.MCP, right middle cerebellar peduncle.

Table 1:

Patient characteristics

Variable/Category	No. (%)
Age at diagnosis
3 yr or older	120 (91.6)
Younger than 3 yr	11 (8.4)
Sex
Female	78 (59.6)
Male	53 (40.4)
Ethnicity
Asian	2 (1.5)
Asian and white	1 (0.8)
Black	18 (13.8)
Black and white	3 (2.3)
Multiple	5 (3.8)
Other	2 (1.5)
Unknown	2 (1.5)
White	98 (74.8)
Metastasis at the end of progression-free survival?
Yes	24 (18.3)
Spinal	7 (5.3)
Intracranial	4 (3.1)
Intracranial + spinal	13 (9.9)
No	112 (85.5)

Table 2:

Tumor volumes at baseline

VOI	No. (%)	Mean Volume (cm³) (Range)	No. Enhancing (%)
TTV	131 (100.0)	40.0279 (8.9750–110.8010)	106 (80.92)
PTV	131 (100.0)	36.1874 (8.9750–100.8550)
ETV	125 (95.4)	4.03311 (0.2840–16.9780)	42 (33.6)
EPLE, medulla oblongata	101 (77.1)	0.96112 (0.1910–4.5400)	9 (8.91)
EPLE, right MCP	44 (33.6)	1.9368 (0.0410–7.4560)	14 (31.11)
EPLE, left MCP	44 (33.6)	1.7811 (0.0750–7.8440)	6 (11.54)
EPLE, any MCP	81 (61.8)	2.0196 (0.0410–7.8440)	18 (22.22)
EPLE, midbrain	109 (83.2)	2.23375 (0.1380–11.9460)	23 (21.50)