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

T2/FLAIR Abnormity Could be the Sign of Glioblastoma Dissemination

Mingxiao Li  1   2 , Wei Huang  1   2 , Hongyan Chen  3 , Haihui Jiang  4 , Chuanwei Yang  1   2 , Shaoping Shen  1   2 , Yong Cui  1   2 , Gehong Dong  5 , Xiaohui Ren  1   2   6 , Song Lin  1   2   6
Affiliations

T2/FLAIR Abnormity Could be the Sign of Glioblastoma Dissemination

Mingxiao Li et al. Front Neurol. .

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).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Patients included in this study. The final analysis showed that 25.9% of patients (44/170) presented discordant results between T2/FLAIR and T1CE images.
Figure 2
Figure 2
A representative case for the discordant subgroup with distant intracranial metastasis. (A) The patient presented unbearable headache with contrast-enhancing (CE) lesion on left temporal (a–d). Craniotomy was performed and the tumor was totally removed. The final diagnose was primary GBM, IDH wild-type, WHO grade 4 (e–f). (B) Forty-nine months after the operation, a non-CE lesion on the splenium of the corpus callosum with space-occupying effect (a–d) was suspected tumor progression. The final pathology diagnosis was GBM, IDH wild-type, WHO grade 4 (e–f) based on the WHO 2021 brain tumor classification system (Bars, 200 μm). GBM, glioblastoma; IDH, isocitrate dehydrogenase.
Figure 3
Figure 3
Prognosis comparison between T2/FLAIR and T1CE discordant and accordant patients. (A–C) The TTP, OS, and PPS were not different between the two subgroups. (D–F) For non-local progression patients, the OS and PPS in discordant subgroup were favorable than accordant subgroup, but not for the TTP. TTP, time to progression; OS, overall survival; PPS, post-progression survival.
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