Neuro-radiological characteristics of adult diffuse grade II and III insular gliomas classified according to WHO 2016

  • Compes Paloma
  • Tabouret Emeline
  • Etcheverry Amandine
  • Colin Carole
  • Appay Romain
  • Cordier Nicolas
  • Mosser Jean
  • Chinot Olivier
  • Delingette Hervé
  • Girard Nadine
  • Dufour Henry
  • Metellus Philippe
  • Figarella-Branger DominiqueEmail author
Clinical Study



The phenotypic heterogeneity of diffuse gliomas is still inconsistently explained by known molecular abnormalities. Here, we report the molecular and radiological features of diffuse grade WHO II and III gliomas involving the insula and its potential impact on prognosis.


Clinical, pathological, molecular and neuro-radiological features of 43 consecutive patients who underwent a surgical resection between 2006 and 2013 for a grade II and III gliomas involving the insula was retrospectively analyzed.


Median age was 44.4 years. Eight patients had oligodendrogliomas, IDH mutant (IDHmut) and 1p/19q-codeleted (6 grade II, 2 grade III). Twenty-eight patients had diffuse astrocytomas, IDHmut (22 grade II and 6 grade III) and seven patients had grade II diffuse astrocytomas, IDHwt (A-IDHwt). Vimentin staining was exclusively recorded in tumor cells from A-IDHwt (p = 0.001). Mean cerebral blood volume (CBV) (p = 0.018), maximal value of CBV (p = 0.017) and ratio of the corrected CBV (p = 0.022) were lower for A-IDHwt. Volumetric segmentation of ADC allowed the identification of the tumor cores, which were smaller in A-IDHwt (p < 0.001). The tumor occurrences of A-IDHwt were exclusively located into the temporo-insular region. Median progression-free survival (PFS) and overall survival (OS) were 50.9 months (95% CI: 26.7–75.0) and 80.9 months (60.1–101.6). By multivariate analysis, A-IDHwt (p = 0.009; p = 0.019), 7p gain and 10q loss (p = 0.009; p = 0.016) and vimentin positive staining (p = 0.011; p = 0.029) were associated with poor PFS and OS respectively.


Insular low-grade A-IDHwt presented with poor prognosis despite a smaller tumor core and no evidence of increased perfusion on MR imaging.


Glioma Insula Perfusion Molecular Neuro-radiology 



This work was supported by grants from Institut National du Cancer (Grant No. INCa-DGOS-Inserm 6038), from the Cancéropôle PACA (Grant No. 2015-02 INSUL802) and the GEFLUC Marseille Provence (Groupement Entreprises Françaises Lutte contre le Cancer—PVM-2014-241). We thank the AP-HM Tumor Bank (Authorization Number: AC2018-31053; CRB BB-0033-00097) for providing tissue samples. We also thank the ARTC-Sud patients’s association (Association pour le Recherche sur les Tumeurs Cérébrales).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 5 (DOCX 38 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Compes Paloma
    • 1
    • 2
  • Tabouret Emeline
    • 1
    • 3
  • Etcheverry Amandine
    • 4
  • Colin Carole
    • 1
  • Appay Romain
    • 1
    • 5
  • Cordier Nicolas
    • 6
  • Mosser Jean
    • 4
  • Chinot Olivier
    • 1
    • 3
  • Delingette Hervé
    • 6
  • Girard Nadine
    • 7
  • Dufour Henry
    • 2
  • Metellus Philippe
    • 1
    • 8
  • Figarella-Branger Dominique
    • 1
    • 5
    Email author
  1. 1.Aix-Marseille Univ, CNRS UMR 7051, INP, Inst NeurophysiopatholMarseilleFrance
  2. 2.AP-HM, Hôpital de la Timone, Service de NeurochirurgieMarseilleFrance
  3. 3.AP-HM, Hôpital de la Timone, Service de NeurooncologieMarseilleFrance
  4. 4.Integrated Functional Genomics and Biomarkers Team, UMR6290, CNRS, Université de Rennes 1RennesFrance
  5. 5.AP-HM, Hôpital de la Timone, Service d’AnatomopathologieMarseilleFrance
  6. 6.Université Côte d’Azur and Inria Sophia-Antipolis Méditerranée Asclepios Team, Inria Sophia AntipolisSophia AntipolisFrance
  7. 7.Aix Marseille University UMR CNRS 7339, APHM Timone hospitalMarseilleFrance
  8. 8.Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de SanteMarseilleFrance

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