Immediate post-operative MRI suggestive of the site and timing of glioblastoma recurrence after gross total resection: a
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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 Thibault Smets & Tévi Morel Lawson & Cécile Grandin & Aleksandar Jankovski & Christian Raftopoulos
Received: 12 September 2012 / Accepted: 11 December 2012 / Published online: 12 January 2013 # European Society of Radiology 2013
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 postoperative and early post-operative MRI with the first follow-up MRI demonstrating recurrence authorised T. Smets : T. M. Lawson : C. Raftopoulos Department of Neurosurgery, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium A. Jankovski (*) Department of Neurosurgery, Centre Hospitalier Universitaire Mont-Godinne, Université catholique de Louvain, Avenue G. Thérasse 1, 5530 Yvoir, Belgium e-mail: [email protected] C. Grandin Department of Radiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium A. Jankovski Laboratory of Algology, Institute of Neuroscience, SSS/IoNS, Université catholique de Louvain, Avenue Mounier 53, Bte B1.53.04, 1200 Brussels, Belgium
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 grossTR 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 progressionfree 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
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