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Low-Grade Diffuse Astrocytoma
Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Diffuse astrocytoma, grade II astrocytoma, fibrillary astrocytoma, low-grade astrocytoma (LGA)
            • Definitions

              • Primary brain tumor of astrocytic origin with intrinsic tendency for malignant progression, degeneration into anaplastic astrocytoma (AA)
              • Well-differentiated but infiltrating neoplasm, slow growth pattern

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Arevalo-Perez J et al: Dynamic Contrast-Enhanced Perfusion MRI and Diffusion-Weighted Imaging in Grading of Gliomas. J Neuroimaging. ePub, 2015
                                            2. Jia ZZ et al: The assessment of immature microvascular density in brain gliomas with dynamic contrast-enhanced magnetic resonance imaging. Eur J Radiol. ePub, 2015
                                            3. Johnston DL et al: Low grade astrocytoma in children under the age of three years: a report from the Canadian pediatric brain tumour consortium. J Neurooncol. 124(1):95-100, 2015
                                            4. Ogura R et al: Immunohistochemical profiles of IDH1, MGMT and P53: Practical significance for prognostication of patients with diffuse gliomas. Neuropathology. 35(4):324-35, 2015
                                            5. Reuss DE et al: IDH mutant diffuse and anaplastic astrocytomas have similar age at presentation and little difference in survival: a grading problem for WHO. Acta Neuropathol. 129(6):867-73, 2015
                                            6. Reuss DE et al: ATRX and IDH1-R132H immunohistochemistry with subsequent copy number analysis and IDH sequencing as a basis for an "integrated" diagnostic approach for adult astrocytoma, oligodendroglioma and glioblastoma. Acta Neuropathol. 129(1):133-46, 2015
                                            7. Waqar M et al: Prognostic Factors in Lobar World Health Organization Grade II Astrocytomas. World Neurosurg. 84(1):154-62, 2015
                                            8. Xiao HF et al: Astrocytic tumour grading: a comparative study of three-dimensional pseudocontinuous arterial spin labelling, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and diffusion-weighted imaging. Eur Radiol. ePub, 2015
                                            9. Appin CL et al: Molecular genetics of gliomas. Cancer J. 20(1):66-72, 2014
                                            10. Bisdas S et al: Cerebral blood volume measurements by perfusion-weighted MR imaging in gliomas: ready for prime time in predicting short-term outcome and recurrent disease? AJNR Am J Neuroradiol. 30(4):681-8, 2009
                                            11. Cha S: Neuroimaging in neuro-oncology. Neurotherapeutics. 6(3):465-77, 2009
                                            12. Gasparetto EL et al: Posttreatment recurrence of malignant brain neoplasm: accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction. Radiology. 250(3):887-96, 2009
                                            13. Rizzo L et al: Role of diffusion- and perfusion-weighted MR imaging for brain tumour characterisation. Radiol Med. 114(4):645-659, 2009
                                            14. Scarabino T et al: Role of advanced MR imaging modalities in diagnosing cerebral gliomas. Radiol Med. 114(3):448-60, 2009
                                            15. Sentürk S et al: Dynamic contrast-enhanced susceptibility-weighted perfusion imaging of intracranial tumors: a study using a 3T MR scanner. Diagn Interv Radiol. 15(1):3-12, 2009
                                            16. Danchaivijitr N et al: Low-grade gliomas: do changes in rCBV measurements at longitudinal perfusion-weighted MR imaging predict malignant transformation? Radiology. 247(1):170-8, 2008
                                            17. Law M et al: Gliomas: predicting time to progression or survival with cerebral blood volume measurements at dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Radiology. 247(2):490-8, 2008
                                            18. Noguchi T et al: Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. AJNR Am J Neuroradiol. 29(4):688-93, 2008
                                            19. Tourdias T et al: Pulsed arterial spin labeling applications in brain tumors: practical review. J Neuroradiol. 35(2):79-89, 2008
                                            20. Chawla S et al: Arterial spin-labeling and MR spectroscopy in the differentiation of gliomas. AJNR Am J Neuroradiol. 28(9):1683-9, 2007
                                            21. Ellika SK et al: Role of perfusion CT in glioma grading and comparison with conventional MR imaging features. AJNR Am J Neuroradiol. 28(10):1981-7, 2007
                                            22. Jenkinson MD et al: Advanced MRI in the management of adult gliomas. Br J Neurosurg. 21(6):550-61, 2007
                                            23. Louis DN et al (): WHO Classification of Tumours of the Central Nervous System: Diffuse Astrocytoma. Lyon: IARC Press. 25-9, 2007
                                            24. Oshiro S et al: Quantitative assessment of gliomas by proton magnetic resonance spectroscopy. Anticancer Res. 27(6A):3757-63, 2007
                                            25. Ding B et al: Comparison of cerebral blood volume and permeability in preoperative grading of intracranial glioma using CT perfusion imaging. Neuroradiology. 48(10):773-81, 2006
                                            26. Fan GG et al: Usefulness of diffusion/perfusion-weighted MRI in patients with non-enhancing supratentorial brain gliomas: a valuable tool to predict tumour grading? Br J Radiol. 79(944):652-8, 2006
                                            27. Law M et al: Low-grade gliomas: dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging--prediction of patient clinical response. Radiology. 238(2):658-67, 2006
                                            28. Law M et al: Perfusion magnetic resonance imaging predicts patient outcome as an adjunct to histopathology: a second reference standard in the surgical and nonsurgical treatment of low-grade gliomas. Neurosurgery. 58(6):1099-107; discussion 1099-107, 2006
                                            29. Fayed N et al: The contribution of magnetic resonance spectroscopy and echoplanar perfusion-weighted MRI in the initial assessment of brain tumours. J Neurooncol. 72(3):261-5, 2005
                                            30. Hakyemez B et al: High-grade and low-grade gliomas: differentiation by using perfusion MR imaging. Clin Radiol. 60(4):493-502, 2005
                                            31. Maia AC Jr et al: Stereotactic biopsy guidance in adults with supratentorial nonenhancing gliomas: role of perfusion-weighted magnetic resonance imaging. J Neurosurg. 101(6):970-6, 2004
                                            32. Vuori K et al: Low-grade gliomas and focal cortical developmental malformations: differentiation with proton MR spectroscopy. Radiology. 230(3):703-8, 2004
                                            33. Wessels PH et al: 10q25.3 (DMBT1) copy number changes in astrocytoma grades II and IV. Genes Chromosomes Cancer. 39(1):22-8, 2004
                                            34. Hanzely Z et al: Role of early radiotherapy in the treatment of supratentorial WHO Grade II astrocytomas: long-term results of 97 patients. J Neurooncol. 63(3):305-12, 2003
                                            35. Hara T et al: Use of 18F-choline and 11C-choline as contrast agents in positron emission tomography imaging-guided stereotactic biopsy sampling of gliomas. J Neurosurg. 99(3):474-9, 2003
                                            36. Kuznetsov YE et al: Proton magnetic resonance spectroscopic imaging can predict length of survival in patients with supratentorial gliomas. Neurosurgery. 53(3):565-74; discussion 574-6, 2003
                                            37. Plathow C et al: Fractionated stereotactic radiotherapy in low-grade astrocytomas: long-term outcome and prognostic factors. Int J Radiat Oncol Biol Phys. 57(4):996-1003, 2003
                                            38. Wessels PH et al: Supratentorial grade II astrocytoma: biological features and clinical course. Lancet Neurol. 2(7):395-403, 2003
                                            39. Burger PC et al: Surgical pathology of the nervous system and its coverings: The Brain: Tumors. 4th ed. Philadelphia: Churchill Livingstone. 160-77, 2002
                                            40. Henderson KH et al: Randomized trials of radiation therapy in adult low-grade gliomas. Semin Radiat Oncol. 11(2):145-51, 2001
                                            41. Castillo M et al: Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol. 21(9):1645-9, 2000
                                            42. Kleihues P et al: Pathology and genetics of tumours of the nervous system: Diffuse astrocytoma. Lyon: IARC Press. 22-6, 2000
                                            43. Knopp EA et al: Glial neoplasms: dynamic contrast-enhanced T2*-weighted MR imaging. Radiology. 211(3):791-8, 1999
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Diffuse astrocytoma, grade II astrocytoma, fibrillary astrocytoma, low-grade astrocytoma (LGA)
                                                      • Definitions

                                                        • Primary brain tumor of astrocytic origin with intrinsic tendency for malignant progression, degeneration into anaplastic astrocytoma (AA)
                                                        • Well-differentiated but infiltrating neoplasm, slow growth pattern

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Arevalo-Perez J et al: Dynamic Contrast-Enhanced Perfusion MRI and Diffusion-Weighted Imaging in Grading of Gliomas. J Neuroimaging. ePub, 2015
                                                                                      2. Jia ZZ et al: The assessment of immature microvascular density in brain gliomas with dynamic contrast-enhanced magnetic resonance imaging. Eur J Radiol. ePub, 2015
                                                                                      3. Johnston DL et al: Low grade astrocytoma in children under the age of three years: a report from the Canadian pediatric brain tumour consortium. J Neurooncol. 124(1):95-100, 2015
                                                                                      4. Ogura R et al: Immunohistochemical profiles of IDH1, MGMT and P53: Practical significance for prognostication of patients with diffuse gliomas. Neuropathology. 35(4):324-35, 2015
                                                                                      5. Reuss DE et al: IDH mutant diffuse and anaplastic astrocytomas have similar age at presentation and little difference in survival: a grading problem for WHO. Acta Neuropathol. 129(6):867-73, 2015
                                                                                      6. Reuss DE et al: ATRX and IDH1-R132H immunohistochemistry with subsequent copy number analysis and IDH sequencing as a basis for an "integrated" diagnostic approach for adult astrocytoma, oligodendroglioma and glioblastoma. Acta Neuropathol. 129(1):133-46, 2015
                                                                                      7. Waqar M et al: Prognostic Factors in Lobar World Health Organization Grade II Astrocytomas. World Neurosurg. 84(1):154-62, 2015
                                                                                      8. Xiao HF et al: Astrocytic tumour grading: a comparative study of three-dimensional pseudocontinuous arterial spin labelling, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and diffusion-weighted imaging. Eur Radiol. ePub, 2015
                                                                                      9. Appin CL et al: Molecular genetics of gliomas. Cancer J. 20(1):66-72, 2014
                                                                                      10. Bisdas S et al: Cerebral blood volume measurements by perfusion-weighted MR imaging in gliomas: ready for prime time in predicting short-term outcome and recurrent disease? AJNR Am J Neuroradiol. 30(4):681-8, 2009
                                                                                      11. Cha S: Neuroimaging in neuro-oncology. Neurotherapeutics. 6(3):465-77, 2009
                                                                                      12. Gasparetto EL et al: Posttreatment recurrence of malignant brain neoplasm: accuracy of relative cerebral blood volume fraction in discriminating low from high malignant histologic volume fraction. Radiology. 250(3):887-96, 2009
                                                                                      13. Rizzo L et al: Role of diffusion- and perfusion-weighted MR imaging for brain tumour characterisation. Radiol Med. 114(4):645-659, 2009
                                                                                      14. Scarabino T et al: Role of advanced MR imaging modalities in diagnosing cerebral gliomas. Radiol Med. 114(3):448-60, 2009
                                                                                      15. Sentürk S et al: Dynamic contrast-enhanced susceptibility-weighted perfusion imaging of intracranial tumors: a study using a 3T MR scanner. Diagn Interv Radiol. 15(1):3-12, 2009
                                                                                      16. Danchaivijitr N et al: Low-grade gliomas: do changes in rCBV measurements at longitudinal perfusion-weighted MR imaging predict malignant transformation? Radiology. 247(1):170-8, 2008
                                                                                      17. Law M et al: Gliomas: predicting time to progression or survival with cerebral blood volume measurements at dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Radiology. 247(2):490-8, 2008
                                                                                      18. Noguchi T et al: Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. AJNR Am J Neuroradiol. 29(4):688-93, 2008
                                                                                      19. Tourdias T et al: Pulsed arterial spin labeling applications in brain tumors: practical review. J Neuroradiol. 35(2):79-89, 2008
                                                                                      20. Chawla S et al: Arterial spin-labeling and MR spectroscopy in the differentiation of gliomas. AJNR Am J Neuroradiol. 28(9):1683-9, 2007
                                                                                      21. Ellika SK et al: Role of perfusion CT in glioma grading and comparison with conventional MR imaging features. AJNR Am J Neuroradiol. 28(10):1981-7, 2007
                                                                                      22. Jenkinson MD et al: Advanced MRI in the management of adult gliomas. Br J Neurosurg. 21(6):550-61, 2007
                                                                                      23. Louis DN et al (): WHO Classification of Tumours of the Central Nervous System: Diffuse Astrocytoma. Lyon: IARC Press. 25-9, 2007
                                                                                      24. Oshiro S et al: Quantitative assessment of gliomas by proton magnetic resonance spectroscopy. Anticancer Res. 27(6A):3757-63, 2007
                                                                                      25. Ding B et al: Comparison of cerebral blood volume and permeability in preoperative grading of intracranial glioma using CT perfusion imaging. Neuroradiology. 48(10):773-81, 2006
                                                                                      26. Fan GG et al: Usefulness of diffusion/perfusion-weighted MRI in patients with non-enhancing supratentorial brain gliomas: a valuable tool to predict tumour grading? Br J Radiol. 79(944):652-8, 2006
                                                                                      27. Law M et al: Low-grade gliomas: dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging--prediction of patient clinical response. Radiology. 238(2):658-67, 2006
                                                                                      28. Law M et al: Perfusion magnetic resonance imaging predicts patient outcome as an adjunct to histopathology: a second reference standard in the surgical and nonsurgical treatment of low-grade gliomas. Neurosurgery. 58(6):1099-107; discussion 1099-107, 2006
                                                                                      29. Fayed N et al: The contribution of magnetic resonance spectroscopy and echoplanar perfusion-weighted MRI in the initial assessment of brain tumours. J Neurooncol. 72(3):261-5, 2005
                                                                                      30. Hakyemez B et al: High-grade and low-grade gliomas: differentiation by using perfusion MR imaging. Clin Radiol. 60(4):493-502, 2005
                                                                                      31. Maia AC Jr et al: Stereotactic biopsy guidance in adults with supratentorial nonenhancing gliomas: role of perfusion-weighted magnetic resonance imaging. J Neurosurg. 101(6):970-6, 2004
                                                                                      32. Vuori K et al: Low-grade gliomas and focal cortical developmental malformations: differentiation with proton MR spectroscopy. Radiology. 230(3):703-8, 2004
                                                                                      33. Wessels PH et al: 10q25.3 (DMBT1) copy number changes in astrocytoma grades II and IV. Genes Chromosomes Cancer. 39(1):22-8, 2004
                                                                                      34. Hanzely Z et al: Role of early radiotherapy in the treatment of supratentorial WHO Grade II astrocytomas: long-term results of 97 patients. J Neurooncol. 63(3):305-12, 2003
                                                                                      35. Hara T et al: Use of 18F-choline and 11C-choline as contrast agents in positron emission tomography imaging-guided stereotactic biopsy sampling of gliomas. J Neurosurg. 99(3):474-9, 2003
                                                                                      36. Kuznetsov YE et al: Proton magnetic resonance spectroscopic imaging can predict length of survival in patients with supratentorial gliomas. Neurosurgery. 53(3):565-74; discussion 574-6, 2003
                                                                                      37. Plathow C et al: Fractionated stereotactic radiotherapy in low-grade astrocytomas: long-term outcome and prognostic factors. Int J Radiat Oncol Biol Phys. 57(4):996-1003, 2003
                                                                                      38. Wessels PH et al: Supratentorial grade II astrocytoma: biological features and clinical course. Lancet Neurol. 2(7):395-403, 2003
                                                                                      39. Burger PC et al: Surgical pathology of the nervous system and its coverings: The Brain: Tumors. 4th ed. Philadelphia: Churchill Livingstone. 160-77, 2002
                                                                                      40. Henderson KH et al: Randomized trials of radiation therapy in adult low-grade gliomas. Semin Radiat Oncol. 11(2):145-51, 2001
                                                                                      41. Castillo M et al: Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol. 21(9):1645-9, 2000
                                                                                      42. Kleihues P et al: Pathology and genetics of tumours of the nervous system: Diffuse astrocytoma. Lyon: IARC Press. 22-6, 2000
                                                                                      43. Knopp EA et al: Glial neoplasms: dynamic contrast-enhanced T2*-weighted MR imaging. Radiology. 211(3):791-8, 1999