The Radiologic Features of Cystic versus Noncystic Glioblastoma Multiforme as Significant Prognostic Factors

Choi, Seung Joon; Kim, Na Rae; Lee, Sheen Woo; Kim, Jeong-Ho; Choi, Hye Young; Kim, Hyung Sik

doi:10.3348/jksr.2010.63.4.299

“…Collectively, previous studies have shown mixed results on the OS benefit of cystic GBM against noncystic GBM patients. The majority of studies observing an OS benefit for cystic GBM contain patients diagnosed before the current SOC [2,4,5,23] more recent publications tend not to observe an OS benefit [3,7,8]. As described above, we have shown a significant increase in OS for cystic GBM patients when compared to noncystic GBM patients.…”

Section: Discussionsupporting

confidence: 49%

“…Another study of 5 cystic GBMs and 32 noncystic GBMs treated between 1990 and 2004 also found that patients with cystic GBM had a longer time to recurrence and a median survival time of 19.8 months compared to only 12.8 months for noncystic GBM [4]. A smaller study of 7 cystic and 14 noncystic GBMs treated between 2000 and 2009 found that patients with cystic GBM lived significantly longer after surgery [5]. Another recent study of patients with GBM treated between 2004 and 2014 found a survival benefit for those with cystic GBM (41 cystic, 139 noncystic) [6].…”

Section: Introductionmentioning

confidence: 96%

Assessment of Prognostic Value of Cystic Features in Glioblastoma Relative to Sex and Treatment with Standard-of-Care

Curtin

¹

,

Whitmire

²

,

Rickertsen

³

et al. 2019

Preprint

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Glioblastoma (GBM) is the most aggressive primary brain tumor and can have cystic components, identifiable through magnetic resonance imaging (MRI). Previous studies suggest that cysts occur in 7-23% of GBMs and report mixed results regarding their prognostic impact. Using our retrospective cohort of 493 patients with first-diagnosis GBM, we carried out an exploratory analysis on this potential link between cystic GBM and survival. Using pretreatment MRIs, we manually identified 88 patients with GBM that had a significant cystic component at presentation and 405 patients that did not. Patients with cystic GBM had significantly longer overall survival and were significantly younger at presentation. Within patients who received the current standard of care (SOC) (N=184, 40 cystic), we did not observe a survival benefit of cystic GBM. Unexpectedly, we did not observe a significant survival benefit between this SOC cystic cohort and patients with cystic GBM diagnosed before the standard was established (N=40 with SOC, N=19 without SOC); this significant SOC benefit was clearly observed in patients with noncystic GBM (N=144 with SOC, N=111 without SOC). When stratified by sex, this significant survival benefit was only preserved in male patients (N=303, 47 cystic). We report differences in the absolute and relative sizes of imaging abnormalities on MRI and the prognostic implication of cysts based on sex. We discuss hypotheses for these differences, including the possibility that the presence of a cyst could indicate a less aggressive tumor.Methods: Using pretreatment MRIs, we manually identified 88 patients with GBM that had a significant cystic component at presentation. Results: Compared to patients with noncystic GBM (N=405), patients with cystic GBM had significantly longer overall survival and were significantly younger at presentation. However, among patients who received the current standard-of-care treatment, cystic GBM (N=40) was not significant for outcome. We also did not observe a significant survival benefit when comparing this standard-of-care cystic cohort to patients with cystic GBM diagnosed before the standard was established (N=19), but the analogous result for patients with noncystic GBM gives a sizeable benefit, as expected (N=144, N=111, respectively). We also report differences in the absolute and relative sizes of imaging abnormalities on MRI and the prognostic implication of cysts based on sex. Conclusion: Together, these results may explain later studies that note no significant survival benefit for patients with cystic GBM receiving current standard-of-care. We discuss hypotheses for these observed differences, including the possibility that the presence of a cyst could indicate a less aggressive tumor.

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“…Collectively, previous studies have shown mixed results on the OS benefit of cystic GBM against noncystic GBM patients. The majority of studies observing an OS benefit for cystic GBM contain patients diagnosed before the current SOC (4,(6)(7)(8)19). As described above, we have shown a significant increase in OS for cystic GBM patients when compared to noncystic GBM patients in a cohort of 493 patients (88 cystic GBM).…”

Section: Discussionmentioning

confidence: 99%

“…Another study of 5 cystic GBMs and 32 noncystic GBMs treated between 1990 and 2004 also found that patients with cystic GBM had a longer time to recurrence and a median survival time of 19.8 months compared to only 12.8 months for noncystic GBM (6). This is supported by a smaller study of 7 cystic and 14 noncystic GBMs treated between 2000 and 2009 that found patients with cystic GBM lived significantly longer after surgery (7). Another recent study of patients with GBM treated between 2004 and 2014 found a survival benefit FIGURE 1 | Example T1Gd and T2 MR images from noncystic and cystic GBM patients.…”

Section: Introductionmentioning

confidence: 86%

Assessment of Prognostic Value of Cystic Features in Glioblastoma Relative to Sex and Treatment With Standard-of-Care

Curtin

¹

,

Whitmire

²

,

Rickertsen

³

et al. 2020

View full text Add to dashboard Cite

Glioblastoma (GBM) is the most aggressive primary brain tumor and can have cystic components, identifiable through magnetic resonance imaging (MRI). Previous studies suggest that cysts occur in 7–23% of GBMs and report mixed results regarding their prognostic impact. Using our retrospective cohort of 493 patients with first-diagnosis GBM, we carried out an exploratory analysis on this potential link between cystic GBM and survival. Using pretreatment MRIs, we manually identified 88 patients with GBM that had a significant cystic component at presentation and 405 patients that did not. Patients with cystic GBM had significantly longer overall survival and were significantly younger at presentation. Within patients who received the current standard of care (SOC) ( N = 184, 40 cystic), we did not observe a survival benefit of cystic GBM. Unexpectedly, we did not observe a significant survival benefit between this SOC cystic cohort and patients with cystic GBM diagnosed before the standard was established ( N = 40 with SOC, N = 19 without SOC); this significant SOC benefit was clearly observed in patients with noncystic GBM ( N = 144 with SOC, N = 111 without SOC). When stratified by sex, the survival benefit of cystic GBM was only preserved in male patients ( N = 303, 47 cystic). We report differences in the absolute and relative sizes of imaging abnormalities on MRI and the prognostic implication of cysts based on sex. We discuss hypotheses for these differences, including the possibility that the presence of a cyst could indicate a less aggressive tumor.

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“…27 The other schools of thought regarding the basis of cyst formation are necrotic degeneration of the tumour tissue, central haemorrhage and subsequent liquefaction, entrapment of adjacent CSF space and blood–brain barrier disruption. 28…”

Section: Cystic Glioblastomamentioning

confidence: 99%

The many faces of glioblastoma: Pictorial review of atypical imaging features

Khandwala

¹

,

Mubarak

²

,

Minhas

³

2020

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Glioblastoma is an aggressive primary central nervous system tumour that usually has a poor prognosis. Generally, the typical imaging features are easily recognisable, but the behaviour of glioblastoma multiforme (GBM) can often be unusual. Several variations and heterogeneity in GBM appearance have been known to occur. In this pictorial essay, we present cases of pathologically confirmed GBM that illustrate unusual locations and atypical features on neuroimaging, and review the relevant literature. Even innocuous-looking foci, cystic lesions, meningeal-based pathology, intraventricular and infra-tentorial masses, multifocal/multicentric lesions and spinal cord abnormalities may represent GBM. We aim to highlight the atypical characteristics of glioblastoma, clarify their importance and list the potential mimickers. Although a definitive diagnosis in these rare cases of GBM warrants histopathological confirmation, an overview of the many imaging aspects may help make an early diagnosis.

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The Radiologic Features of Cystic versus Noncystic Glioblastoma Multiforme as Significant Prognostic Factors

Cited by 12 publications

References 20 publications

Assessment of Prognostic Value of Cystic Features in Glioblastoma Relative to Sex and Treatment with Standard-of-Care

Assessment of Prognostic Value of Cystic Features in Glioblastoma Relative to Sex and Treatment with Standard-of-Care

Assessment of Prognostic Value of Cystic Features in Glioblastoma Relative to Sex and Treatment With Standard-of-Care

The many faces of glioblastoma: Pictorial review of atypical imaging features

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