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@ARTICLE{Weller:309607,
      author       = {J. Weller and D. Harba and L. Kuschel and F. Thiele and S.
                      Katzendobler and A. Corell and A. Dénes and M.
                      Schmutzer-Sondergeld and E. de Dios and F. Ringel and J. C.
                      Tonn$^*$ and A. S. Jakola},
      title        = {{A}ssociation of a diffuse phenotype on {MRI} with shorter
                      overall survival in patients with astrocytoma {CNS} {WHO}
                      grades 2 and 3.},
      journal      = {Journal of neurosurgery},
      volume       = {nn},
      issn         = {0022-3085},
      address      = {Charlottesville, Va.},
      publisher    = {American Assoc. of Neurological Surgeons},
      reportid     = {DKFZ-2026-00257},
      pages        = {nn},
      year         = {2026},
      note         = {#DKTKZFB9# / epub},
      abstract     = {Gliomas can appear radiologically diffuse or sharply
                      delineated on MRI. This can be quantified by the T1/T2
                      ratio, a quotient of the T1 hypointense to T2 hyperintense
                      tumor volume. In patients with CNS WHO grade 2 and 3
                      isocitrate dehydrogenase (IDH)-mutant astrocytomas,
                      resectability has been shown to be limited in cases of low
                      T1/T2 ratios, that is, in diffusely appearing astrocytomas.
                      The authors set out to investigate if a diffuse phenotype on
                      MRI is associated with overall survival beyond
                      resectability.Retrospective data sets from two university
                      hospitals (Sahlgrenska University Hospital, Gothenburg,
                      Sweden; LMU University Hospital, Munich, Germany) were
                      screened for patients diagnosed with 2021 CNS WHO grade 2
                      and 3 astrocytomas by biopsy between 2003 and 2021. Patients
                      having undergone tumor resection were excluded. Tumor
                      volumes were segmented and the T1/T2 ratio was calculated.
                      Propensity score matching (nearest-neighbor matching, 1:1)
                      was used.One hundred nineteen patients with CNS WHO grade 2
                      (n = 77, $65\%)$ or grade 3 (n = 42, $35\%)$ IDH-mutant
                      astrocytomas were included in the study. In unadjusted
                      analyses, survival was not significantly shorter in patients
                      with a T1/T2 ratio ≤ 0.33 (144 vs 126 months; HR 0.61,
                      $95\%$ CI 0.34-1.1; p = 0.09). Propensity score matching
                      (Karnofsky Performance Status, CNS WHO 2021 grade, contrast
                      enhancement on MRI, and T2 tumor volume) yielded 29 pairs.
                      Here, significantly shorter overall survival was observed in
                      patients with a T1/T2 ratio ≤ 0.33 (160 vs 132 months; HR
                      0.44, $95\%$ CI 0.19-1.00; p = 0.05). In multivariate
                      analysis, only the T1/T2 ratio persisted as a prognostic
                      factor (HR 0.48, $95\%$ CI 0.25-0.92; p = 0.03).A diffuse
                      phenotype on MRI seems to be associated with shorter
                      survival times in patients with CNS WHO grade 2 and 3
                      astrocytomas. These findings warrant further investigation
                      in prospective data sets.},
      keywords     = {IDH mutation (Other) / biopsy (Other) / diagnostic
                      technique (Other) / low-grade glioma (Other) / oncology
                      (Other) / prognosis (Other) / risk factor (Other) / tumor
                      volume (Other)},
      cin          = {MU01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41616295},
      doi          = {10.3171/2025.9.JNS251254},
      url          = {https://inrepo02.dkfz.de/record/309607},
}