Illuminating radiogenomic signatures in pediatric-type diffuse gliomas: insights into molecular, clinical, and imaging correlations. Part II: low-grade group.
Authors
Affiliations (15)
Affiliations (15)
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan. [email protected].
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
- Department of Artificial Intelligence, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
- Department of Radiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
- Department of Radiation Oncology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
- Department of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan.
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
- Department of Diagnostic Radiology, Kansai Electric Power Hospital, Osaka, Japan.
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Abstract
The fifth edition of the World Health Organization classification of central nervous system tumors represents a significant advancement in the molecular-genetic classification of pediatric-type diffuse gliomas. This article comprehensively summarizes the clinical, molecular, and radiological imaging features in pediatric-type low-grade gliomas (pLGGs), including MYB- or MYBL1-altered tumors, polymorphous low-grade neuroepithelial tumor of the young (PLNTY), and diffuse low-grade glioma, MAPK pathway-altered. Most pLGGs harbor alterations in the RAS/MAPK pathway, functioning as "one pathway disease". Specific magnetic resonance imaging features, such as the T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign in MYB- or MYBL1-altered tumors and the transmantle-like sign in PLNTYs, may serve as non-invasive biomarkers for underlying molecular alterations. Recent advances in radiogenomics have enabled the differentiation of BRAF fusion from BRAF V600E mutant tumors based on magnetic resonance imaging characteristics. Machine learning approaches have further enhanced our ability to predict molecular subtypes from imaging features. These radiology-molecular correlations offer potential clinical utility in treatment planning and prognostication, especially as targeted therapies against the MAPK pathway emerge. Continued research is needed to refine our understanding of genotype-phenotype correlations in less common molecular alterations and to validate these imaging biomarkers in larger cohorts.