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Immediate post-operative MRI suggestive of the site and timing of glioblastoma recurrence after gross total resection: a retrospective longitudinal preliminary study

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Abstract

Objectives

To retrospectively identify morphological and physiological post-operative magnetic resonance imaging (MRI) characteristics predictive of glioblastoma recurrences after gross total resection (gross-TR).

Methods

Resection margins of 24 glioblastoma were analysed immediately post-operatively (MRI ≤ 2 h) and early post-operatively (24 h ≤ MRI ≤ 48 h), and subdivided into areas with and without subtle contrast enhancement previously considered non-specific. On follow-up MRI, tumour regrowth areas were subdivided according to recurrence extent (focally/extended) and delay (≤6 and ≥12 months). Co-registration of pre-operative, immediately post-operative and early post-operative MRI with the first follow-up MRI demonstrating recurrence authorised their morphological (contrast enhancements) and physiological (rCBV) characterisation.

Results

Morphologically, on immediately post-operative MRI, micro-nodular and frayed enhancements correlate significantly with early recurrences (≤6 months). After gross-TR the absence of these enhancements is associated with a significant increase in progression-free survival (61 vs 15 weeks respectively) and overall survival (125 vs 51 weeks respectively). Physiologically, areas with a future focal recurrence have a trend toward higher rCBV than other areas.

Conclusion

Immediately post-operative topography of micro-nodular and frayed enhancements is suggestive of recurrence location and delay. Absence of such enhancements is associated with a fourfold increase in progression-free survival and a 2.5-fold increase in overall survival.

Key Points

• Immediately post-operative MRI reveals contrast enhancement after glioblastoma gross total resection.

• Immediately post-operative micro-nodular and frayed enhancement correlate with early recurrence.

• Absence of micro-nodular/frayed enhancement is associated with 61 weeks’ progression-free survival.

• Absence of micro-nodular/frayed enhancement is associated with 125 weeks’ overall survival.

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Abbreviations

Gd:

Gadolinium

(n)TG:

(no) tumour growth

Op:

Operative

OS:

Overall survival

PFS:

Progression-free survival

PPV:

Positive predictive value

PWI:

Perfusion-weighted imaging

rCBV:

Relative cerebral blood volume

ROI:

Region of interest

TR:

Total resection

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Acknowledgments

First authors: T. Smets and T. M. Lawson contributed equally to the manuscript. Last authors: A. Jankovski and C. Raftopoulos contributed equally to the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Thibault Smets, Tévi Morel Lawson & Christian Raftopoulos

  2. Department of Neurosurgery, Centre Hospitalier Universitaire Mont-Godinne, Université catholique de Louvain, Avenue G. Thérasse 1, 5530, Yvoir, Belgium

    Aleksandar Jankovski

  3. Department of Radiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Cécile Grandin

  4. Laboratory of Algology, Institute of Neuroscience, SSS/IoNS, Université catholique de Louvain, Avenue Mounier 53, Bte B1.53.04, 1200, Brussels, Belgium

    Aleksandar Jankovski

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  1. Thibault Smets
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  2. Tévi Morel Lawson
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  3. Cécile Grandin
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  4. Aleksandar Jankovski
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Correspondence to Aleksandar Jankovski.

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Smets, T., Lawson, T.M., Grandin, C. et al. Immediate post-operative MRI suggestive of the site and timing of glioblastoma recurrence after gross total resection: a retrospective longitudinal preliminary study. Eur Radiol 23, 1467–1477 (2013). https://doi.org/10.1007/s00330-012-2762-1

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  • DOI: https://doi.org/10.1007/s00330-012-2762-1

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