title: Early MRI changes in glioblastoma in the period between surgery and adjuvant therapy.
abstract: To investigate the increase in MRI contrast enhancement (CE) occurring in glioblastoma during the period between surgery and initiation of chemo-radiotherapy, thirty-seven patients with newly diagnosed glioblastoma were analyzed by early post-operative magnetic resonance (EPMR) imaging within three days of surgery and by pre-adjuvant magnetic resonance (PAMR) examination before adjuvant therapy. Areas of new CE were investigated by use of EPMR diffusion-weighted imaging and PAMR perfusion imaging (by arterial spin-labeling). PAMR was acquired, on average, 29.9 days later than EPMR (range 20-37 days). During this period an increased area of CE was observed for 17/37 patients. For 3/17 patients these regions were confined to areas of reduced EPMR diffusion, suggesting postsurgical infarct. For the other 14/17 patients, these areas suggested progression. For 11/17 patients the co-occurrence of hyperperfusion in PAMR perfusion suggested progression. PAMR perfusion and EPMR diffusion did not give consistent results for 3/17 patients for whom small new areas of CE were observed, presumably because of the poor spatial resolution of perfusion imaging. Before initiation of adjuvant therapy, areas of new CE of resected glioblastomas are frequently observed. Most of these suggest tumor progression, according to EPMR diffusion and PAMR perfusion criteria.
authors.affiliation: Anatomy and Histology Section, Department of Morphological and Biomedical Sciences, University of Verona, Via Le Grazie 8, 37134 Verona, VR, Italy. paolofarace@gmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Farace
authors.forename: Dante
authors.initials: D
authors.lastname: Amelio
authors.forename: Giuseppe K
authors.initials: GK
authors.lastname: Ricciardi
authors.forename: Giada
authors.initials: G
authors.lastname: Zoccatelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Magon
authors.forename: Francesca
authors.initials: F
authors.lastname: Pizzini
authors.forename: Franco
authors.initials: F
authors.lastname: Alessandrini
authors.forename: Andrea
authors.initials: A
authors.lastname: Sbarbati
authors.forename: Maurizio
authors.initials: M
authors.lastname: Amichetti
authors.forename: Alberto
authors.initials: A
authors.lastname: Beltramello
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D003287:Contrast Media