title: Imaging features of invasion and preoperative and postoperative tumor burden in previously untreated glioblastoma: Correlation with survival.
abstract: BACKGROUND
  A paucity of data exists concerning the prognostic usefulness of preoperative and postoperative imaging after resection of glioblastoma multiforme (GBM). This study aimed to connect outcome with imaging features of GBM.
  
  
  METHODS
  Retrospective computer-assisted volumetric calculations quantified central necrotic (T0), gadolinium-enhanced (T1) and increased T2-weighted signal volumes (T2) in 70 patients with untreated GBM. Clinical and treatment data, including extent of resection (EOR), were obtained through chart review. T1 volume was used as a measure of solid tumor burden; and T2 volume, as an indicator of invasive isolated tumor cell (ITC) burden. Indicators of invasiveness included T2:T1 ratios as a propensity for ITC infiltration compared to solid tumor volumes and qualitative analysis of subependymal growth and infiltration of the basal ganglia, corpus callosum or brainstem. Cox multivariate analysis (CMVA) was used to identify significant associations between imaging features and survival.
  
  
  RESULTS
  In the 70 patients studied, significant associations with reduced survival existed for gadolinium-enhancing tumor crossing the corpus callosum (odds ratio, 3.14) and with increased survival with gross total resection (GTR) (GTR median survival, 62 weeks versus 37 and 34 weeks for sub-total resection and biopsy, respectively). For a selected "GTR-eligible" subgroup of 52 patients, prolonged survival was associated with smaller preoperative gadolinium-enhancing volume (T1) and actual GTR.
  
  
  CONCLUSIONS
  Some magnetic resonance (MR) imaging indicators of tumor invasiveness (gadolinium-enhancing tumor crossing the corpus callosum) and tumor burden (GTR and preoperative T1 volume in GTR-eligible subgroup) correlate with survival. However, ITC-infiltrative tumor burden (T2 volume) and "propensity" for ITC invasiveness (T2:T1 ratio) did not impact survival. These results indicate that while the ITC component is the ultimate barrier to cure for GBM, the pattern of spread and volumes of gadolinium-enhancing solid tumor are more robust indicators of prognosis.
authors.affiliation: Departments of Neurological Surgery, University of Washington, Seattle, US.
authors.forename: Rohan
authors.initials: R
authors.lastname: Ramakrishna
authors.forename: Jason
authors.initials: J
authors.lastname: Barber
authors.forename: Greg
authors.initials: G
authors.lastname: Kennedy
authors.forename: Adnan
authors.initials: A
authors.lastname: Rizvi
authors.forename: Robert
authors.initials: R
authors.lastname: Goodkin
authors.forename: Richard H
authors.initials: RH
authors.lastname: Winn
authors.forename: George A
authors.initials: GA
authors.lastname: Ojemann
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Spence
authors.forename: Robert C
authors.initials: RC
authors.lastname: Rostomily