T2/FLAIR Abnormity Could be the Sign of Glioblastoma Dissemination

Mingxiao Li; Wei Huang; Hongyan Chen; Haihui Jiang; Chuanwei Yang; Shaoping Shen; Yong Cui; Gehong Dong; Xiaohui Ren; Song Lin

doi:10.3389/fneur.2022.819216

T2/FLAIR Abnormity Could be the Sign of Glioblastoma Dissemination

Front Neurol. 2022 Feb 2:13:819216. doi: 10.3389/fneur.2022.819216. eCollection 2022.

Authors

Mingxiao Li^{1

2}, Wei Huang^{1

2}, Hongyan Chen³, Haihui Jiang⁴, Chuanwei Yang^{1

2}, Shaoping Shen^{1

2}, Yong Cui^{1

2}, Gehong Dong⁵, Xiaohui Ren^{1

2

6}, Song Lin^{1

2

6}

Affiliations

¹ Department of Neurosurgical Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
³ Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.
⁵ Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁶ Department of Neuroscience, Beijing Key Laboratory of Brain Tumor, Institute for Brain Disorders, Center of Brain Tumor, Beijing, China.

Abstract

Purpose: Newly emerged or constantly enlarged contrast-enhancing (CE) lesions were the necessary signs for the diagnosis of glioblastoma (GBM) progression. This study aimed to investigate whether the T2-weighted-Fluid-Attenuated Inversion Recovery (T2/FLAIR) abnormal transformation could predict and assess progression for GBMs, especially for tumor dissemination.

Methods: A consecutive cohort of 246 GBM patients with regular follow-up and sufficient radiological data was included in this study. The series of T2/FLAIR and T1CE images were retrospectively reviewed. The patients were separated into T2/FLAIR and T1CE discordant and accordant subgroups based on the initial progression images.

Results: A total of 170 qualified patients were finally analyzed. The incidence of discordant T2/FLAIR and T1CE images was 25.9% (44/170). The median time-span of T2/FLAIR indicated tumor progression was 119.5 days (ranging from 57 days-unreached) prior to T1CE. Nearly half of patients (20/44, 45.5%) in the discordant subgroup suffered from tumor dissemination, substantially higher than accordant patients (23/126, 20.6%, p < 0.001). The median time to progression (TTP), post-progression survival (PPS), and overall survival (OS) were not statistically different (all p > 0.05) between discordant and accordant patients.

Conclusions: T2/FLAIR abnormity could be the sign of GBM progression, especially for newly emerged lesions disseminating from the primary cavity. Physicians should cast more attention on the dynamic change of T2/FLAIR images, which might be of great significance for progression assessment and subsequent clinical decision-making.

Keywords: RANO; T2/FLAIR; dissemination; glioblastoma (GBM); gross total removal of tumor (GTR); isocitrate dehydrogenase (IDH); progression; supratotal maximal resection (SMR).