BACKGROUND MRI postcontrast nonenhanced brain tumors are found benign biologic entities with the better prognosis. The aim of this paper is to evaluate predictive features on MRI considered definite diagnosis occurrence, tumor progression, upgrading and postcontrast enhancement evolution on follow-up serial MRI. MATERIAL AND METHODS We retrospectively collected patients with the initially MRI postcontrast nonenhanced brain tumors, treated in our hospital from January 2009 to June 1, 2006. All tumors were converted into WHO 2016 IDH status classifications in accordance with current recommendations. Information about surgeries, patient clinical condition, MRI, and results of histological, immunohistochemical, molecular genetic, and cytogenetic investigations were gathered. Semiautomatic segmentations were performed using FSLeyes software (part of FSL package) on preoperative and followed-up 3D T1-w MPRAGE, T2-w or FLAIR scans. We focused on residual tumor volume, and time distribution of T2/FLAIR changes and T1-w postcontrast enhancement evolution. RESULTS Seventy-eight patients were enrolled in this study. There were 47 gliomas grade II 22 grade III and 9 grade IV. Glioma II comprised 35 diffuse astrocytomas (23 patients had IDH1 mutation). Nine gliomas grade III and 6 gliomas grade IV had IDH1 mutation. Overall survival in glioma group grade II, grade III, grade IV was 187.9 months, 71.1 months and 25.2 months, respectively. Oncotherapy underwent 14 gliomas grade II after first surgery, 13 patients had radiotherapy a 1 patient had neoadjuvant chemotherapy. Seventeen gliomas grade III were indicated to oncotherapy, 5 patients had radiotherapy and 12 had chemoradiotherapy. All patients with glioma grade IV experienced oncotherapy. Time to progression of non-contrast enhanced brain tumor was 5.8 years. Time to up-grading of non-contrast enhanced brain tumor was 16.8 months. Detailed time relations of glioma subgroup will be displayed in tables. CONCLUSION Regarding MRI postcontrast non-enhanced tumors, predominantly low grade gliomas (LGG), aggressive oncotherapy are reluctant to use but they are prone to repeat surgeries. Decision making issues are age, clinical patient status, histologic and genetic tumor characteristics, residual tumor volume, published guidelines for brain tumor treatment, and patient′s willing. Generally, hyposignal on the T1 postcontrast scans strictly relate to the better prognosis, even in HGG. Longer survival expectancy increases quality of life awareness. Prior to MRI postcontrast enhanced evolution and up-grading, T2/FLAIR changes have been demonstrated. T2/FLAIR scans considered also main role in LGG follow-up strategy. Individual tailored therapy is principal strategy. Supported by Ministry of Health of the Czech Republic, grant nr. NV19-04-00281 and grant nr. NU21-03-00195

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P09.05 MRI增强后非增强胶质瘤的治疗策略

背景 MRI 增强后非增强脑肿瘤是良性生物实体，预后较好。本文的目的是评估 MRI 的预测特征，考虑到后续连续 MRI 的明确诊断发生、肿瘤进展、升级和增强后的演变。材料和方法 我们回顾性收集了 2009 年 1 月至 2006 年 6 月 1 日期间在我院接受治疗的最初 MRI 增强后未增强脑肿瘤的患者。所有肿瘤均根据当前建议转换为 WHO 2016 IDH 状态分类。收集了有关手术、患者临床状况、MRI 以及组织学、免疫组化、分子遗传学和细胞遗传学研究结果的信息。使用 FSLeyes 软件（FSL 软件包的一部分）对术前和后续 3D T1-w MPRAGE、T2-w 或 FLAIR 扫描进行半自动分割。我们专注于残余肿瘤体积、T2/FLAIR 变化的时间分布和 T1-w 增强后的演变。结果 78 名患者参加了这项研究。有 47 个胶质瘤 II 级，22 个 III 级和 9 个 IV 级。胶质瘤 II 包括 35 个弥漫性星形细胞瘤（23 名患者有 IDH1 突变）。9 个 III 级胶质瘤和 6 个 IV 级胶质瘤具有 IDH1 突变。II级、III级、IV级胶质瘤组的总生存期分别为187.9个月、71.1个月和25.2个月。肿瘤治疗在第一次手术后接受了 14 例 II 级胶质瘤，13 例患者接受了放疗，1 例患者接受了新辅助化疗。17 例 III 级胶质瘤被指示进行肿瘤治疗，放疗5例，放化疗12例。所有IV级胶质瘤患者都接受了肿瘤治疗。非对比增强脑肿瘤的进展时间为 5.8 年。非对比增强脑肿瘤的升级时间为16.8个月。胶质瘤亚组的详细时间关系将以表格形式显示。结论 对于 MRI 增强后非增强肿瘤，主要是低级别胶质瘤 (LGG)，积极的肿瘤治疗不愿意使用，但它们容易重复手术。决策问题包括年龄、临床患者状态、组织学和遗传肿瘤特征、残余肿瘤体积、已发表的脑肿瘤治疗指南以及患者的意愿。通常，T1 增强后扫描的低信号与较好的预后密切相关，即使在 HGG 中也是如此。更长的生存预期提高了生活质量意识。在 MRI 增强后增强进化和升级之前，已经证明了 T2/FLAIR 变化。T2/FLAIR 扫描也被认为在 LGG 后续策略中的主要作用。个体化定制治疗是主要策略。由捷克共和国卫生部支持，授予编号。NV19-04-00281 并授予 nr。NU21-03-00195