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Glioblastoma
Luke L. Linscott, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            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

                                              1. 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
                                              2. 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
                                              3. Blasel S et al: Perfusion MRI in the Evaluation of Suspected Glioblastoma Recurrence. J Neuroimaging. ePub, 2015
                                              4. 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
                                              5. Iagaru A et al: Glioblastoma Multiforme Recurrence: An Exploratory Study of 18F FPPRGD2 PET/CT. Radiology. 141550, 2015
                                              6. Ideguchi M et al: MRI findings and pathological features in early-stage glioblastoma. J Neurooncol. 123(2):289-97, 2015
                                              7. 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
                                              8. Mabray MC et al: Modern brain tumor imaging. Brain Tumor Res Treat. 3(1):8-23, 2015
                                              9. Melguizo-Gavilanes I et al: Characterization of pseudoprogression in patients with glioblastoma: is histology the gold standard? J Neurooncol. 123(1):141-50, 2015
                                              10. Pope WB: Genomics of brain tumor imaging. Neuroimaging Clin N Am. 25(1):105-19, 2015
                                              11. 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
                                              12. 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
                                              13. 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
                                              14. 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
                                              15. 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
                                              16. 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
                                              17. Martin V et al: Encountering and advancing through antiangiogenesis therapy for gliomas. Curr Pharm Des. 15(4):353-64, 2009
                                              18. McGirt MJ et al: Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme. J Neurosurg. 110(3):583-8, 2009
                                              19. Miletic H et al: Anti-VEGF therapies for malignant glioma: treatment effects and escape mechanisms. Expert Opin Ther Targets. 13(4):455-68, 2009
                                              20. Oshiro S et al: Efficacy of temozolomide treatment in patients with high-grade glioma. Anticancer Res. 29(3):911-7, 2009
                                              21. 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
                                              22. 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
                                              23. 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
                                              24. 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
                                              25. 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
                                              26. 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
                                              27. 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
                                              28. Louis DN et al: WHO classification of tumours of the central nervous system: glioblastoma. Lyon: IARC Press. 33-49, 2007
                                              29. 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
                                              30. Calli C et al: Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol. 58(3):394-403, 2006
                                              31. 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
                                              32. 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
                                              33. 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
                                              34. Hakyemez B et al: Glioblastoma multiforme with atypical diffusion-weighted MR findings. Br J Radiol. 78(935):989-92, 2005
                                              35. 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
                                              36. Maldaun MV et al: Cystic glioblastoma multiforme: survival outcomes in 22 cases. J Neurosurg. 100(1):61-7, 2004
                                              37. 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
                                              38. 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
                                              39. 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
                                              40. Lüdemann L et al: Comparison of dynamic contrast-enhanced MRI with WHO tumor grading for gliomas. Eur Radiol. 11(7):1231-41, 2001
                                              41. Castillo M et al: Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol. 21(9):1645-9, 2000
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        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

                                                                                          1. 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
                                                                                          2. 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
                                                                                          3. Blasel S et al: Perfusion MRI in the Evaluation of Suspected Glioblastoma Recurrence. J Neuroimaging. ePub, 2015
                                                                                          4. 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
                                                                                          5. Iagaru A et al: Glioblastoma Multiforme Recurrence: An Exploratory Study of 18F FPPRGD2 PET/CT. Radiology. 141550, 2015
                                                                                          6. Ideguchi M et al: MRI findings and pathological features in early-stage glioblastoma. J Neurooncol. 123(2):289-97, 2015
                                                                                          7. 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
                                                                                          8. Mabray MC et al: Modern brain tumor imaging. Brain Tumor Res Treat. 3(1):8-23, 2015
                                                                                          9. Melguizo-Gavilanes I et al: Characterization of pseudoprogression in patients with glioblastoma: is histology the gold standard? J Neurooncol. 123(1):141-50, 2015
                                                                                          10. Pope WB: Genomics of brain tumor imaging. Neuroimaging Clin N Am. 25(1):105-19, 2015
                                                                                          11. 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
                                                                                          12. 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
                                                                                          13. 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
                                                                                          14. 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
                                                                                          15. 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
                                                                                          16. 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
                                                                                          17. Martin V et al: Encountering and advancing through antiangiogenesis therapy for gliomas. Curr Pharm Des. 15(4):353-64, 2009
                                                                                          18. McGirt MJ et al: Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme. J Neurosurg. 110(3):583-8, 2009
                                                                                          19. Miletic H et al: Anti-VEGF therapies for malignant glioma: treatment effects and escape mechanisms. Expert Opin Ther Targets. 13(4):455-68, 2009
                                                                                          20. Oshiro S et al: Efficacy of temozolomide treatment in patients with high-grade glioma. Anticancer Res. 29(3):911-7, 2009
                                                                                          21. 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
                                                                                          22. 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
                                                                                          23. 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
                                                                                          24. 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
                                                                                          25. 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
                                                                                          26. 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
                                                                                          27. 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
                                                                                          28. Louis DN et al: WHO classification of tumours of the central nervous system: glioblastoma. Lyon: IARC Press. 33-49, 2007
                                                                                          29. 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
                                                                                          30. Calli C et al: Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol. 58(3):394-403, 2006
                                                                                          31. 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
                                                                                          32. 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
                                                                                          33. 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
                                                                                          34. Hakyemez B et al: Glioblastoma multiforme with atypical diffusion-weighted MR findings. Br J Radiol. 78(935):989-92, 2005
                                                                                          35. 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
                                                                                          36. Maldaun MV et al: Cystic glioblastoma multiforme: survival outcomes in 22 cases. J Neurosurg. 100(1):61-7, 2004
                                                                                          37. 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
                                                                                          38. 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
                                                                                          39. 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
                                                                                          40. Lüdemann L et al: Comparison of dynamic contrast-enhanced MRI with WHO tumor grading for gliomas. Eur Radiol. 11(7):1231-41, 2001
                                                                                          41. Castillo M et al: Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol. 21(9):1645-9, 2000