Prognostic significance of preoperative MRI scans in glioblastoma multiforme

Abstract

Tumor necrosis, enhancement, and associated edema in patients with glioblastoma multiforme (GBM) represent biological variables that can be quantitated on preoperative MRI scans. We reviewed 48 highly selected patients, all of whom had supratentorial lesions, had undergone gross total tumor resection, and had received adjuvant treatments (radio- and chemotherapies). None of these patients had had surgery for recurrent tumor resection and none had harbored multifocal tumors. The median age was 50 years. The median Karnofsky performance score was 80. Multivariate analysis using the Cox regression model revealed that the strongest prognostic variable was the amount of tumor necrosis on preoperative scan (P < 0.001), with median survivals of 42, 24, 15, and 12 months for tumor necrosis grades of 0 (7 'pts'), I (11 'pts'), II (9 'pts'), and III (21 'pts'), respectively. The intensity of enhancement of the tumor nodule was another prognostic factor (P = 0.003), with median survivals of 35, 18, and 13.5 months for enhancement grades of 0 (2 'pts'), I (22 'pts'), and II (24 'pts'), respectively. The extent of peritumoral edema had a quadratic effect (P = 0.001), with grades I (19 'pts'), II (22 'pts'), and III (7 'pts') surviving for 24, 12, and 20 months respectively. Location and volume of tumors were not statistically significant predictors of survival (P < 0.05). In conclusion, in this highly selected group, GBM patients with little or no necrosis and with less tumor nodule enhancement on preoperative MRI survive longer than patients with greater amounts of necrosis and greater degrees of tumor enhancement. In addition, a moderate degree of peritumoral edema is associated with worse prognosis.

Improved Treatment Efficacy of Antiangiogenic Therapy when Combined with Picornavirus Vaccination in the GL261 Glioma Model

“…GBM typically presents with both gadolinium-enhancement, as visible by T1-weighted MRI with contrast, and significant peritumoral edema, as seen by T2-weighted imaging [52][53][54]. Tumor response and relapse have historically been detected following the same criteria.…”

“…The GL261-Quad cell line is engineered to express the model antigens human gp100 [25][26][27][28][29][30][31][32][33] , chicken OVA 257-264 , chicken OVA [323][324][325][326][327][328][329][330][331][332][333][334][335][336][337][338][339] , and mouse alloantigen I-Ea [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] . Female 6-8-week-old C57BL/6 mice (The Jackson Laboratory, Bar Harbor, ME, USA) were inoculated by stereotactic injection of 6.0×10 4 -1.0×10 5 GL261 or GL261-Quad cells into the right striatum.…”

Tumour enhancing fraction (EnF) in glioma: relationship to tumour grade

“…Conventional imaging relies upon the radiologist's subjective ability to identify enhancement following intravenous administration of contrast agents. Subjective contrast enhancement is seen in almost all high grade and some low grade glioma [10,11]. Subtle changes, due to minimal enhancement, are open to errors of interpretation and a number of groups have described quantitative approaches.…”

Detection of T2 changes in an early mouse brain tumor

“…The presence of invading tumor cells and neovascularization is thought to be the most important [22]. The presence of increased T 2 -weighted peritumoral signal suggests a worse clinical prognosis in patients with high-grade glioma [23]. Additionally, the elaboration of multiple cytokines by endothelial tumor cells contributes to the generation of vasogenic edema [22].…”