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MRI Classification and Stages of Early Glioblastomas: Awareness Precedes Change

出版	Morressier, 2017
URL	http://books.google.com.hk/books?id=GJ-vzQEACAAJ&hl=&source=gbs_api

註釋MRI Classification and Stages of Early Glioblastomas: Awareness Precedes ChangePURPOSE/OBJECTIVES Glioblastomas (GBs) are typically large when diagnosed and their prognosis remains poor with a 5-year survival rate typically less than 5%. Clinically, it is uncommon to detect small GBs and more unusual to document progressive growth of small to large tumors by MRI. It is important to be familiar with imaging findings and growth patterns of early GBs as it may help diagnosis and allow total resection that potentially improves survival.APPROACHPatients with initial MRI studies demonstrating early-stage GBs obtained from 2 academic institutions are included here. A previously published MR classification describing MRI findings of early-stage GBs was used and selected patients are presented along with clinical information, IDH mutation status and survival information. Early-stage GBs were defined as small MRI lesions demonstrating abnormal signal intensity on T2/FLAIR, and/or postcontrast T1-weighted images but with absence of imaging findings of classic GB such as necrosis, hemorrhage, prominent edema, and heterogeneous contrast enhancement. The lesions were followed and grew and were all subsequently proven to be GBs by histopathology.FINDINGS:3 types of early-stage GBs representing 3 sequential stages of tumor growth were observed. The earliest MRI-detectable abnormalities were non-contrast enhancing FLAIR/T2 hyperintensities found in the cerebral cortex, deep gray nuclei, hippocampi and dentate nuclei. Subsequently the lesions extended to adjacent white matter demonstrating FLAIR/T2 hyperintensities. Contrast-enhancing nodules then appeared at gray-white matter junctions, and became classic GBs by progressive enlargement.SUMMARYAwareness of imaging features and progressive growth patterns of early-stage GBs is important as these small tumors can progress to classic GBs in short intervals. Early detection of GBs may facilitate a change in current management, understanding of gliomagenesis and development of new therapies.