Prediction of H3K27M Alteration Status in Brainstem Glioma Using Multi-Shell Diffusion MRI Metrics

Background: Multi-shell diffusion characteristics may help characterize brainstem gliomas (BSGs) and predict H3K27M status. // Purpose: To identify the diffusion characteristics of BSG patients and investigate the predictive values of various diffusion metrics for H3K27M status in BSG. // Study Type: Prospective. // Population: Eighty-four BSG patients (median age 10.5 years [IQR 6.8–30.0 years]) were included, of whom 56 were pediatric and 28 were adult patients. // Field Strength/Sequence: 3 T, multi-shell diffusion imaging. // Assessment: Diffusion kurtosis imaging and neurite orientation dispersion and density imaging analyses were performed. Age, gender, and diffusion metrics, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, radial diffusivity (RD), mean kurtosis (MK), axial kurtosis (AK), radial kurtosis, intracellular volume fraction (ICVF), orientation dispersion index, and isotropic volume fraction (ISOVF), were compared between H3K27M-altered and wildtype BSG patients. // Statistical Tests: Chi-square test, Mann–Whitney U test, multivariate analysis of variance (MANOVA), step-wise multivariable logistic regression. P-values