title: Tumor Infiltration in Enhancing and Non-Enhancing Parts of Glioblastoma: A Correlation with Histopathology.
abstract: OBJECTIVE
  To correlate histopathologic findings from biopsy specimens with their corresponding location within enhancing areas, non-enhancing areas and necrotic areas on contrast enhanced T1-weighted MRI scans (cT1).
  
  
  METHODS
  In 37 patients with newly diagnosed glioblastoma who underwent stereotactic biopsy, we obtained a correlation of 561 1mm3 biopsy specimens with their corresponding position on the intraoperative cT1 image at 1.5 Tesla. Biopsy points were categorized as enhancing (CE), non-enhancing (NE) or necrotic (NEC) on cT1 and tissue samples were categorized as "viable tumor cells", "blood" or "necrotic tissue (with or without cellular component)". Cell counting was done semi-automatically.
  
  
  RESULTS
  NE had the highest content of tissue categorized as viable tumor cells (89% vs. 60% in CE and 30% NEC, respectively). Besides, the average cell density for NE (3764 ± 2893 cells/mm2) was comparable to CE (3506 ± 3116 cells/mm2), while NEC had a lower cell density with 2713 ± 3239 cells/mm2. If necrotic parts and bleeds were excluded, cell density in biopsies categorized as "viable tumor tissue" decreased from the center of the tumor (NEC, 5804 ± 3480 cells/mm2) to CE (4495 ± 3209 cells/mm2) and NE (4130 ± 2817 cells/mm2).
  
  
  CONCLUSIONS
  The appearance of a glioblastoma on a cT1 image (circular enhancement, central necrosis, peritumoral edema) does not correspond to its diffuse histopathological composition. Cell density is elevated in both CE and NE parts. Hence, our study suggests that NE contains considerable amounts of infiltrative tumor with a high cellularity which might be considered in resection planning.
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.|Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.|German Cancer Consortium (DKTK), Radiology, Heidelberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Eidel
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.|Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.|German Cancer Consortium (DKTK), Radiology, Heidelberg, Germany.
authors.forename: Sina
authors.initials: S
authors.lastname: Burth
authors.affiliation: Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Jan-Oliver
authors.initials: JO
authors.lastname: Neumann
authors.affiliation: Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
authors.forename: Pascal J
authors.initials: PJ
authors.lastname: Kieslich
authors.affiliation: Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Sahm
authors.affiliation: Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Jungk
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kickingereder
authors.affiliation: Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bickelhaupt
authors.affiliation: Department of Neurology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Sibu
authors.initials: S
authors.lastname: Mundiyanapurath
authors.affiliation: Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Bäumer
authors.affiliation: Department of Neurology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wick
authors.affiliation: Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Kiening
authors.affiliation: Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Unterberg
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bendszus
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.|Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.|German Cancer Consortium (DKTK), Radiology, Heidelberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Radbruch
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002452:Cell Count; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D059906:Neuroimaging / Q000379:methods; D012189:Retrospective Studies; D013238:Stereotaxic Techniques