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Review
. 2010 Nov;67(5):1319-27; discussion 1327-8.
doi: 10.1227/NEU.0b013e3181f556ab.

Magnetic resonance imaging characteristics of glioblastoma multiforme: implications for understanding glioma ontogeny

Leif-Erik Bohman  1 , Kristin R Swanson, Julia L Moore, Russ Rockne, Christopher Mandigo, Todd Hankinson, Marcela Assanah, Peter Canoll, Jeffrey N Bruce
Affiliations
Review

Magnetic resonance imaging characteristics of glioblastoma multiforme: implications for understanding glioma ontogeny

Leif-Erik Bohman et al. Neurosurgery. 2010 Nov.

Abstract

Background: Identifying the origin of gliomas carries important implications for advancing the treatment of these recalcitrant tumors. Recent research promotes the hypothesis of a subventricular zone (SVZ) origin for the stemlike gliomagenic cells identified within human glioma specimens. However, conflicting evidence suggests that SVZ-like cells are not uniquely gliomagenic but this capacity may be shared by cycling progenitors distributed throughout the subcortical white matter (SCWM).

Objective: To review radiological evidence in glioblastoma multiforme (GBM) patients to provide insight into the question of glioma ontogeny.

Methods: We explored whether GBMs at first diagnosis demonstrated a pattern of anatomic distribution consistent with origin at the SVZ through retrospective analysis of preoperative contrast-enhanced T1-weighted magnetic resonance images in 63 patients. We then examined the relationship of tumor volume, point of origin, and proximity to the ventricles using a computer model of glioma growth.

Results: Fewer than half of the GBMs analyzed had contrast-enhancing portions that contacted the ventricle on preoperative imaging. A strong correlation was found between tumor volume and the distance between the contrast-enhancing edge of the tumor and the ventricle, demonstrating that tumors abutting the ventricle are significantly larger than those that do not. The lesions simulated by the computer model validated our assumption that tumors that are radiographically distant from the ventricles are unlikely to have originated in the SVZ and supported our hypothesis that as they grow, the edges of all tumors will near the ventricles, regardless of their point of origin.

Conclusion: This work offers further support for the hypothesis that the origins of GBMs are at sites distributed throughout the white matter and are not limited to the region of the SVZ.

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Conflict of interest statement

Disclosure

This work was made possible in part by a Doris Duke Clinical Research Fellowship (Dr Bohman), National Institutes of Health grant RO1 CA 89395 (Dr Bruce), a Mary Gates Research Scholarship (J.L. Moore), and a 21st Century Scientist Award from the McDonnell Foundation (Dr Swanson and R. Rockne). The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.

Figures

FIGURE 1
FIGURE 1
A, edge-to-ventricle distance (EVD) plotted against tumor volume for tumors not abutting the ventricle; the best-fit line is shown. Tumor volume and EVD showed significant negative correlation (Spearman r = −0.53, P = .001). B, center point–to-ventricle distance (CPVD) plotted against tumor volume for tumors abutting the ventricle; the best-fit line is shown. Tumor volume and CPVD showed significant positive correlation (Spearman r = 0.93, P < .001). The same analysis performed on tumors not abutting the ventricle showed no significant correlation between CPVD and tumor volume (Spearman r = 0.18, P = .31).
FIGURE 2
FIGURE 2
Results of serial imaging for study patient 23.
FIGURE 3
FIGURE 3
Example screenshots from glioma growth model simulations with varied points of origin. Images at 4 time points each for 3 simulated lesions provided in the sagittal, coronal, and axial planes for lesion start points at the anterior dorsolateral subventricular zone, anterior deep white matter, and anterior superficial white matter. Green area reflects estimated T2-weighted image abnormality on magnetic resonance; red area reflects estimated T1-weighted image postgadolinium abnormality.
FIGURE 4
FIGURE 4
A, center point–to-ventricle distance (CPVD) plotted against T1-weighted, gadolinium-enhanced (T1Gd) volume for tumor simulations starting in the subventricular zone. B, CPVD and EVD plotted against T1Gd volume for tumor simulations starting in the white matter.
FIGURE 5
FIGURE 5
Distance from origin to center of T1-weighted, gadolinium-enhanced (T1Gd) volume of simulated lesion for (A) subventricular zone and (B) subcortical white matter (SCWM) start points.
See this image and copyright information in PMC

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