Fig. 4.

Hypermutated tumors are at increased risk of developing discontiguous disease after transformation. Cumulative incidence of discontiguous disease from the time of transformation, stratified by hypermutation status (A), Grade (B), Molecular subtype (C). The cumulative incidence of discontiguous disease dichotomized by the mean time-to-transformation (D). Representative images of ependymal, leptomeningeal, and parenchymal patterns of recurrence on T1 contrast-enhanced MRI and distribution for HM and non-HM tumors (E). Representative spine imaging from all four patients with leptomeningeal disease who were found to have spinal dissemination after high-grade transformation (F). Abbreviations: Astro, IDH-mutant Astrocytoma; Oligo, IDH-mutant 1p/19q co-deleted Oligodendroglioma.