T2/FLAIR Abnormity Could Be the Early Sign of Glioblastoma Dissemination

Abstract

PurposeNewly emerged or constantly enlarged contrast-enhancing (CE) instead of T2/FLAIR lesions were the necessary sign for the diagnosis of glioblastoma (GBM) progression. This study aimed to investigate whether the T2/FLAIR abnormal transformation could predict and assess progression for GBMs, especially for dissemination. MethodsA consecutive cohort of 246 de novo GBM with regular follow-up and sufficient radiological data were included in this study. The series of T2/FLAIR, T1CE images were retrospectively reviewed. The patients were separated into T2/FLAIR and T1CE discordant and accordant subgroups based on the initial progression images.ResultsA total of 170 qualified patients were finally analyzed. The incidence of discordant T2/FLAIR and T1CE images was 25.9% (44/170). The median time of T2/FLAIR indicated tumor progression was 119.5 days (ranging from 57 days-unreached) prior to T1CE. Nearly half of patients (20/44, 45.5%) in discordant subgroup suffered from tumor dissemination, substantially higher than accordant patients (23/126, 20.6%, P<0.001). The median time to progression (TTP), post-progression survival (PPS), and overall survival (OS) were not statistically different (all P>0.05) between discordant and accordant patients. Conclusions T2/FLAIR abnormity could be the early sign of GBM progression, especially for newly emerged lesions disseminated from the primary cavity. Physicians should cast more attention on the dynamic change of T2/FLAIR images for progression assessment and subsequent clinical decision-making.