Glioblastoma Recurrence Differential Diagnosis

• Next generation sequencing unravels a gliosarcoma mimicking cerebral osteosarcoma
• Diagnostic value and efficacy of multimodal magnetic resonance imaging in differentiating radiation necrosis from tumor recurrence in glioblastomas
• Immunomodulatory Interventions Based on a Bioinformatics Study of TLR2 in Glioblastoma Multiforme
• Size matters: Biomolecular compositions of small and large extracellular vesicles in the urine of glioblastoma patients
• Testing calpain inhibition in tumor endothelial cells: novel targetable biomarkers against glioblastoma malignancy
• Advances in diffuse glioma assessment: preoperative and postoperative applications of chemical exchange saturation transfer
• Hybrid Positron Emission Tomography and Magnetic Resonance Imaging Guided Microsurgical Management of Glial Tumors: Case Series and Review of the Literature
• lncRNA Biomarkers of Glioblastoma Multiforme

Dynamic Susceptibility Weighted Contrast-Enhanced Perfusion Imaging for glioblastoma recurrence diagnosis

see Macdonald criteria.

see RANO criteria

Radiation necrosis and other normal responses associated with surgical treatment may lead to mimicking of tumor recurrence, also known as glioblastoma pseudoprogression.

Radionecrosis vs recurrent glioblastoma: Despite the fact that a history of prior radiation therapy is usually know at the time of intraoperative consultation, differentiation of the two entities can at times be difficult ¹⁾.

Both lesions often are present simultaneously. Identifying obvious tumor cells and palisading necrosis suggests recurrent/residual glioblastoma. Radiation necrosis, which affects primarily white matter, is supported by large areas of geographic necrosis, sclerosis/hyalinization of vessels or fibrinoid necrosis of vessel walls, perivascular lymphocytes, calcifications, and the presence of macrophages.

In the first couple of months it becomes difficult to differentiate recurrence from glioblastoma pseudoprogression using T2 weighted image, T1 weighted gadolinium, fluid-attenuated inversion-recovery (FLAIR) sequence of MRI ²⁾.

Single-photon emission computed tomography (SPECT), positron emission tomography (PET), perfusion CT, diffusion MRI, perfusion MRI, and magnetic resonance spectroscopy (MRS) are the imaging modalities in the clinical setting.

Determining whether glioblastoma multiforme (Glioblastoma) is progressing despite treatment is challenging due to the pseudoprogression in glioblastoma phenomenon seen on conventional MRIs, but relative cerebral blood volume (CBV) has been shown to be helpful.

Adding perfusion MRI imaging to the combination of Dynamic contrast enhanced MRI CE contrast enhanced T1-weighted imaging and Diffusion weighted magnetic resonance imaging significantly improves the prediction of recurrent glioblastoma; however, selection of perfusion MRI method does not affect the diagnostic performance ³⁾.

The multiparametric 3-T MR assessment based on Proton magnetic resonance spectroscopic imaging (Proton magnetic resonance spectroscopic imagingI), diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) in addition to MRI is a useful tool to discriminate tumour recurrence/progression from radiation effects ⁴⁾.

The regional cerebral blood volume (rCBVmax) in Perfusion MRI differentiates tumor progression from Treatment-related changes (TRC) in unselected recurrent glioblastomas, but it is not predictive for the overall survival (OS) ⁵⁾.

Adding and combining proton MR spectroscopic imaging (Proton magnetic resonance spectroscopic imagingI), diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) information at 3 Tesla facilitate such discrimination ⁶⁾.