Authors: Arian Lasocki Frank Gaillard Mark A Tacey Katharine J Drummond Stephen L Stuckey
Publish Date: 2016/07/13
Volume: 129, Issue: 3, Pages: 471-478
Abstract
Improvements in imaging are increasing the detection of multiple lesions in the setting of glioblastoma Occasionally distant nonenhancing lesions may be identified which have the appearances of a multicentric lowgrade glioma We aimed to determine the incidence prognostic significance and diagnostic value of this appearance in new glioblastoma patients Preoperative MRIs of patients with a new diagnosis of glioblastoma were reviewed to identify multicentric nonenhancing lesions defined as areas of FLAIR hyperintensity and mass effect without postcontrast enhancement separate from the histologicallyproven glioblastoma Patient survival was compared to glioblastoma patients without these appearances and followup imaging was reviewed Nine of 151 patients 6 had multicentric nonenhancing lesions Their median survival of 183 days was significantly worse than the 278 days for patients without multicentric nonenhancing lesions p = 0025 Followup MRIs were performed in four patients In one patient there were several additional lesions one of which developed evidence of necrosis within 22 days of presentation In the other three patients the multicentric lesions developed enhancement and evidence of necrosis within 1 year and became confluent on FLAIR with the dominant lesion The appearance of a multicentric nonenhancing lesion is an uncommon finding in glioblastoma but a poor prognostic feature These lesions progress faster than expected for a lowgrade glioma and are thus likely to represent more advanced lesions than their appearances suggest Confluence with the dominant lesion developing with time suggests that the tumor is more extensive than appreciated on imaging
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