Grade IV astrocytoma, malignant astrocytoma, glioblastoma multiforme (GBM)
Definitions
Rapidly enlarging malignant astrocytic tumor characterized by necrosis and neovascularity
Most common of all primary intracranial neoplasms
IMAGING
General Features
CT Findings
MR Findings
Angiographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Tixier F et al: Preoperative MRI-radiomics features improve prediction of survival in glioblastoma patients over MGMT methylation status alone. Oncotarget. 10(6):660-72, 2019
Hong EK et al: Radiogenomics correlation between MR imaging features and major genetic profiles in glioblastoma. Eur Radiol. 28(10):4350-61, 2018
Lam S et al: Patient and treatment factors associated with survival among pediatric glioblastoma patients: A Surveillance, Epidemiology, and End Results study. J Clin Neurosci. 47:285-93, 2018
Korshunov A et al: H3-/IDH-wild type pediatric glioblastoma is comprised of molecularly and prognostically distinct subtypes with associated oncogenic drivers. Acta Neuropathol. 134(3):507-516, 2017
Liu X et al: The preliminary radiogenomics association between MR perfusion imaging parameters and genomic biomarkers, and their predictive performance of overall survival in patients with glioblastoma. J Neurooncol. 135(3):553-560, 2017
Cui Y et al: Prognostic Imaging Biomarkers in Glioblastoma: Development and Independent Validation on the Basis of Multiregion and Quantitative Analysis of MR Images. Radiology. 278(2):546-53, 2016
Louis DN et al: The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 131(6):803-20, 2016
Nikitović M et al: Pediatric glioblastoma: a single institution experience. Childs Nerv Syst. 32(1):97-103, 2016
Andre JB et al: Cerebral blood flow changes in glioblastoma patients undergoing bevacizumab treatment are seen in both tumor and normal brain. Neuroradiol J. 28(2):112-9, 2015
Bauer AH et al: Differentiation of solitary brain metastasis from glioblastoma multiforme: a predictive multiparametric approach using combined MR diffusion and perfusion. Neuroradiology. 57(7):697-703, 2015
Blasel S et al: Perfusion MRI in the Evaluation of Suspected Glioblastoma Recurrence. J Neuroimaging. ePub, 2015
Harris RJ et al: MRI perfusion measurements calculated using advanced deconvolution techniques predict survival in recurrent glioblastoma treated with bevacizumab. J Neurooncol. 122(3):497-505, 2015
Iagaru A et al: Glioblastoma Multiforme Recurrence: An Exploratory Study of 18F FPPRGD2 PET/CT. Radiology. 141550, 2015
Ideguchi M et al: MRI findings and pathological features in early-stage glioblastoma. J Neurooncol. 123(2):289-97, 2015
Kobayashi K et al: Prognostic value of volume-based measurements on (11)C-methionine PET in glioma patients. Eur J Nucl Med Mol Imaging. 42(7):1071-80, 2015
Mabray MC et al: Modern brain tumor imaging. Brain Tumor Res Treat. 3(1):8-23, 2015
Melguizo-Gavilanes I et al: Characterization of pseudoprogression in patients with glioblastoma: is histology the gold standard? J Neurooncol. 123(1):141-50, 2015
Pope WB: Genomics of brain tumor imaging. Neuroimaging Clin N Am. 25(1):105-19, 2015
Schmainda KM et al: Dynamic susceptibility contrast MRI measures of relative cerebral blood volume as a prognostic marker for overall survival in recurrent glioblastoma: results from the ACRIN 6677/RTOG 0625 multicenter trial. Neuro Oncol. 17(8):1145-56, 2015
Smith TR et al: Use of preoperative FLAIR MRI and ependymal proximity of tumor enhancement as surrogate markers of brain tumor origin. J Clin Neurosci. ePub, 2015
Stadlbauer A et al: Quantification of serial changes in cerebral blood volume and metabolism in patients with recurrent glioblastoma undergoing antiangiogenic therapy. Eur J Radiol. 84(6):1128-36, 2015
Tietze A et al: Perfusion MRI derived indices of microvascular shunting and flow control correlate with tumor grade and outcome in patients with cerebral glioma. PLoS One. 10(4):e0123044, 2015
Barajas RF Jr et al: Benefits of dynamic susceptibility-weighted contrast-enhanced perfusion MRI for glioma diagnosis and therapy. CNS Oncol. 3(6):407-19, 2014
Das KK et al: Pediatric glioblastoma: clinico-radiological profile and factors affecting the outcome. Childs Nerv Syst. 28(12):2055-62, 2012
Mahvash M et al: Glioblastoma multiforme in children: report of 13 cases and review of the literature. Pediatr Neurol. 45(3):178-80, 2011
Perkins SM et al: Glioblastoma in children: a single-institution experience. Int J Radiat Oncol Biol Phys. 80(4):1117-21, 2011
Koukourakis GV et al: Temozolomide with radiation therapy in high grade brain gliomas: pharmaceuticals considerations and efficacy; a review article. Molecules. 14(4):1561-77, 2009
Martin V et al: Encountering and advancing through antiangiogenesis therapy for gliomas. Curr Pharm Des. 15(4):353-64, 2009
McGirt MJ et al: Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme. J Neurosurg. 110(3):583-8, 2009
Miletic H et al: Anti-VEGF therapies for malignant glioma: treatment effects and escape mechanisms. Expert Opin Ther Targets. 13(4):455-68, 2009
Oshiro S et al: Efficacy of temozolomide treatment in patients with high-grade glioma. Anticancer Res. 29(3):911-7, 2009
Paldino MJ et al: Repeatability of quantitative parameters derived from diffusion tensor imaging in patients with glioblastoma multiforme. J Magn Reson Imaging. 29(5):1199-205, 2009
Pirotte BJ et al: Positron emission tomography-guided volumetric resection of supratentorial high-grade gliomas: a survival analysis in 66 consecutive patients. Neurosurgery. 64(3):471-81; discussion 481, 2009
Quinn JA et al: Phase II trial of temozolomide plus o6-benzylguanine in adults with recurrent, temozolomide-resistant malignant glioma. J Clin Oncol. 27(8):1262-7, 2009
Saraswathy S et al: Evaluation of MR markers that predict survival in patients with newly diagnosed GBM prior to adjuvant therapy. J Neurooncol. 91(1):69-81, 2009
Swanson KR et al: Complementary but distinct roles for MRI and 18F-fluoromisonidazole PET in the assessment of human glioblastomas. J Nucl Med. 50(1):36-44, 2009
Wang W et al: Diffusion tensor imaging in glioblastoma multiforme and brain metastases: the role of p, q, L, and fractional anisotropy. AJNR Am J Neuroradiol. 30(1):203-8, 2009
Laprie A et al: Proton magnetic resonance spectroscopic imaging in newly diagnosed glioblastoma: predictive value for the site of postradiotherapy relapse in a prospective longitudinal study. Int J Radiat Oncol Biol Phys. 70(3):773-81, 2008
Louis DN et al: WHO classification of tumours of the central nervous system: glioblastoma. Lyon: IARC Press. 33-49, 2007
Pivawer G et al: Perfusion MR imaging and proton MR spectroscopic imaging in differentiating necrotizing cerebritis from glioblastoma multiforme. Magn Reson Imaging. 25(2):238-43, 2007
Calli C et al: Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol. 58(3):394-403, 2006
Di Costanzo A et al: Spectroscopic, diffusion and perfusion magnetic resonance imaging at 3.0 Tesla in the delineation of glioblastomas: preliminary results. J Exp Clin Cancer Res. 25(3):383-90, 2006
McMillan KM et al: Physiologic characterisation of glioblastoma multiforme using MRI-based hypoxia mapping, chemical shift imaging, perfusion and diffusion maps. J Clin Neurosci. 13(8):811-7, 2006
Stenberg L et al: Dynamic susceptibility contrast-enhanced perfusion magnetic resonance (MR) imaging combined with contrast-enhanced MR imaging in the follow-up of immunogene-treated glioblastoma multiforme. Acta Radiol. 47(8):852-61, 2006
Hakyemez B et al: Glioblastoma multiforme with atypical diffusion-weighted MR findings. Br J Radiol. 78(935):989-92, 2005
Fan G et al: In vivo single-voxel proton MR spectroscopy in the differentiation of high-grade gliomas and solitary metastases. Clin Radiol. 59(1):77-85, 2004
Maldaun MV et al: Cystic glioblastoma multiforme: survival outcomes in 22 cases. J Neurosurg. 100(1):61-7, 2004
Principi M et al: Perfusion MRI in the evaluation of the relationship between tumour growth, necrosis and angiogenesis in glioblastomas and grade 1 meningiomas. Neuroradiology. 45(4):205-11, 2003
Provenzale JM et al: Comparison of permeability in high-grade and low-grade brain tumors using dynamic susceptibility contrast MR imaging. AJR Am J Roentgenol. 178(3):711-6, 2002
Lacroix M et al: A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 95(2):190-8, 2001
Lüdemann L et al: Comparison of dynamic contrast-enhanced MRI with WHO tumor grading for gliomas. Eur Radiol. 11(7):1231-41, 2001
Castillo M et al: Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol. 21(9):1645-9, 2000
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References
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
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TERMINOLOGY
Synonyms
Grade IV astrocytoma, malignant astrocytoma, glioblastoma multiforme (GBM)
Definitions
Rapidly enlarging malignant astrocytic tumor characterized by necrosis and neovascularity
Most common of all primary intracranial neoplasms
IMAGING
General Features
CT Findings
MR Findings
Angiographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Tixier F et al: Preoperative MRI-radiomics features improve prediction of survival in glioblastoma patients over MGMT methylation status alone. Oncotarget. 10(6):660-72, 2019
Hong EK et al: Radiogenomics correlation between MR imaging features and major genetic profiles in glioblastoma. Eur Radiol. 28(10):4350-61, 2018
Lam S et al: Patient and treatment factors associated with survival among pediatric glioblastoma patients: A Surveillance, Epidemiology, and End Results study. J Clin Neurosci. 47:285-93, 2018
Korshunov A et al: H3-/IDH-wild type pediatric glioblastoma is comprised of molecularly and prognostically distinct subtypes with associated oncogenic drivers. Acta Neuropathol. 134(3):507-516, 2017
Liu X et al: The preliminary radiogenomics association between MR perfusion imaging parameters and genomic biomarkers, and their predictive performance of overall survival in patients with glioblastoma. J Neurooncol. 135(3):553-560, 2017
Cui Y et al: Prognostic Imaging Biomarkers in Glioblastoma: Development and Independent Validation on the Basis of Multiregion and Quantitative Analysis of MR Images. Radiology. 278(2):546-53, 2016
Louis DN et al: The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 131(6):803-20, 2016
Nikitović M et al: Pediatric glioblastoma: a single institution experience. Childs Nerv Syst. 32(1):97-103, 2016
Andre JB et al: Cerebral blood flow changes in glioblastoma patients undergoing bevacizumab treatment are seen in both tumor and normal brain. Neuroradiol J. 28(2):112-9, 2015
Bauer AH et al: Differentiation of solitary brain metastasis from glioblastoma multiforme: a predictive multiparametric approach using combined MR diffusion and perfusion. Neuroradiology. 57(7):697-703, 2015
Blasel S et al: Perfusion MRI in the Evaluation of Suspected Glioblastoma Recurrence. J Neuroimaging. ePub, 2015
Harris RJ et al: MRI perfusion measurements calculated using advanced deconvolution techniques predict survival in recurrent glioblastoma treated with bevacizumab. J Neurooncol. 122(3):497-505, 2015
Iagaru A et al: Glioblastoma Multiforme Recurrence: An Exploratory Study of 18F FPPRGD2 PET/CT. Radiology. 141550, 2015
Ideguchi M et al: MRI findings and pathological features in early-stage glioblastoma. J Neurooncol. 123(2):289-97, 2015
Kobayashi K et al: Prognostic value of volume-based measurements on (11)C-methionine PET in glioma patients. Eur J Nucl Med Mol Imaging. 42(7):1071-80, 2015
Mabray MC et al: Modern brain tumor imaging. Brain Tumor Res Treat. 3(1):8-23, 2015
Melguizo-Gavilanes I et al: Characterization of pseudoprogression in patients with glioblastoma: is histology the gold standard? J Neurooncol. 123(1):141-50, 2015
Pope WB: Genomics of brain tumor imaging. Neuroimaging Clin N Am. 25(1):105-19, 2015
Schmainda KM et al: Dynamic susceptibility contrast MRI measures of relative cerebral blood volume as a prognostic marker for overall survival in recurrent glioblastoma: results from the ACRIN 6677/RTOG 0625 multicenter trial. Neuro Oncol. 17(8):1145-56, 2015
Smith TR et al: Use of preoperative FLAIR MRI and ependymal proximity of tumor enhancement as surrogate markers of brain tumor origin. J Clin Neurosci. ePub, 2015
Stadlbauer A et al: Quantification of serial changes in cerebral blood volume and metabolism in patients with recurrent glioblastoma undergoing antiangiogenic therapy. Eur J Radiol. 84(6):1128-36, 2015
Tietze A et al: Perfusion MRI derived indices of microvascular shunting and flow control correlate with tumor grade and outcome in patients with cerebral glioma. PLoS One. 10(4):e0123044, 2015
Barajas RF Jr et al: Benefits of dynamic susceptibility-weighted contrast-enhanced perfusion MRI for glioma diagnosis and therapy. CNS Oncol. 3(6):407-19, 2014
Das KK et al: Pediatric glioblastoma: clinico-radiological profile and factors affecting the outcome. Childs Nerv Syst. 28(12):2055-62, 2012
Mahvash M et al: Glioblastoma multiforme in children: report of 13 cases and review of the literature. Pediatr Neurol. 45(3):178-80, 2011
Perkins SM et al: Glioblastoma in children: a single-institution experience. Int J Radiat Oncol Biol Phys. 80(4):1117-21, 2011
Koukourakis GV et al: Temozolomide with radiation therapy in high grade brain gliomas: pharmaceuticals considerations and efficacy; a review article. Molecules. 14(4):1561-77, 2009
Martin V et al: Encountering and advancing through antiangiogenesis therapy for gliomas. Curr Pharm Des. 15(4):353-64, 2009
McGirt MJ et al: Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme. J Neurosurg. 110(3):583-8, 2009
Miletic H et al: Anti-VEGF therapies for malignant glioma: treatment effects and escape mechanisms. Expert Opin Ther Targets. 13(4):455-68, 2009
Oshiro S et al: Efficacy of temozolomide treatment in patients with high-grade glioma. Anticancer Res. 29(3):911-7, 2009
Paldino MJ et al: Repeatability of quantitative parameters derived from diffusion tensor imaging in patients with glioblastoma multiforme. J Magn Reson Imaging. 29(5):1199-205, 2009
Pirotte BJ et al: Positron emission tomography-guided volumetric resection of supratentorial high-grade gliomas: a survival analysis in 66 consecutive patients. Neurosurgery. 64(3):471-81; discussion 481, 2009
Quinn JA et al: Phase II trial of temozolomide plus o6-benzylguanine in adults with recurrent, temozolomide-resistant malignant glioma. J Clin Oncol. 27(8):1262-7, 2009
Saraswathy S et al: Evaluation of MR markers that predict survival in patients with newly diagnosed GBM prior to adjuvant therapy. J Neurooncol. 91(1):69-81, 2009
Swanson KR et al: Complementary but distinct roles for MRI and 18F-fluoromisonidazole PET in the assessment of human glioblastomas. J Nucl Med. 50(1):36-44, 2009
Wang W et al: Diffusion tensor imaging in glioblastoma multiforme and brain metastases: the role of p, q, L, and fractional anisotropy. AJNR Am J Neuroradiol. 30(1):203-8, 2009
Laprie A et al: Proton magnetic resonance spectroscopic imaging in newly diagnosed glioblastoma: predictive value for the site of postradiotherapy relapse in a prospective longitudinal study. Int J Radiat Oncol Biol Phys. 70(3):773-81, 2008
Louis DN et al: WHO classification of tumours of the central nervous system: glioblastoma. Lyon: IARC Press. 33-49, 2007
Pivawer G et al: Perfusion MR imaging and proton MR spectroscopic imaging in differentiating necrotizing cerebritis from glioblastoma multiforme. Magn Reson Imaging. 25(2):238-43, 2007
Calli C et al: Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol. 58(3):394-403, 2006
Di Costanzo A et al: Spectroscopic, diffusion and perfusion magnetic resonance imaging at 3.0 Tesla in the delineation of glioblastomas: preliminary results. J Exp Clin Cancer Res. 25(3):383-90, 2006
McMillan KM et al: Physiologic characterisation of glioblastoma multiforme using MRI-based hypoxia mapping, chemical shift imaging, perfusion and diffusion maps. J Clin Neurosci. 13(8):811-7, 2006
Stenberg L et al: Dynamic susceptibility contrast-enhanced perfusion magnetic resonance (MR) imaging combined with contrast-enhanced MR imaging in the follow-up of immunogene-treated glioblastoma multiforme. Acta Radiol. 47(8):852-61, 2006
Hakyemez B et al: Glioblastoma multiforme with atypical diffusion-weighted MR findings. Br J Radiol. 78(935):989-92, 2005
Fan G et al: In vivo single-voxel proton MR spectroscopy in the differentiation of high-grade gliomas and solitary metastases. Clin Radiol. 59(1):77-85, 2004
Maldaun MV et al: Cystic glioblastoma multiforme: survival outcomes in 22 cases. J Neurosurg. 100(1):61-7, 2004
Principi M et al: Perfusion MRI in the evaluation of the relationship between tumour growth, necrosis and angiogenesis in glioblastomas and grade 1 meningiomas. Neuroradiology. 45(4):205-11, 2003
Provenzale JM et al: Comparison of permeability in high-grade and low-grade brain tumors using dynamic susceptibility contrast MR imaging. AJR Am J Roentgenol. 178(3):711-6, 2002
Lacroix M et al: A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 95(2):190-8, 2001
Lüdemann L et al: Comparison of dynamic contrast-enhanced MRI with WHO tumor grading for gliomas. Eur Radiol. 11(7):1231-41, 2001
Castillo M et al: Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol. 21(9):1645-9, 2000
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