MRI Atlas of IDH Wild-Type Supratentorial Glioblastoma: Probabilistic Maps of Phenotype, Management, and Outcomes

Abstract

I socitrate dehydrogenase (IDH) wild-type glioblastoma (World Health Organization grade IV astrocytoma) is the most common malignant primary brain tumor in adults (1). Tumor location is a key parameter in the care of patients with glioblastoma because it correlates with demographic characteristics, clinical presentation, histomolecular characteristics, surgical management, delivery of subsequent oncologic treatments, and, therefore, outcomes (2-6). Improvements in imaging after treatment improves the accuracy of neuro-anatomic studies owing to a voxel-based analysis and enables correlation studies. Such probabilistic MRI-based brain atlases have been developed for diffuse low-grade gliomas, including a proposal of a resection probability map (7,8), and high-grade gliomas, including histomolecular findings (9-12), but is lacking for IDH wild-type glioblastomas.Focusing on patients with supratentorial newly diagnosed IDH wild-type glioblastomas in adults in current practice and who received modern standard-of-care treatment (13), we aimed to assess the correlation between tumor location and (a) clinical presentation (age, symptoms, Karnofsky performance status), (b) surgical management

Topographical Mapping of 436 Newly Diagnosed IDH Wildtype Glioblastoma With vs. Without MGMT Promoter Methylation

“…Therefore, studies must be conducted based on homogeneous tumor populations with respect to IDH mutational status. This hypothesis was recently supported by Roux et al, who assessed a homogenous IDH wildtype glioblastoma population (n = 392) and found no difference in localization between glioblastoma with and without MGMT methylation, in line with our study (21).…”

Glioblastoma Distance From the Subventricular Neural Stem Cell Niche Does Not Correlate With Survival

“…Hence, we pooled the datasets to address this limitation, yielding a more constant and precise range of confidence interval around the hazard ratio, which remained steady around 1 (Figures 2D, F). Our results are in accordance with MRI probabilistic maps of glioblastoma that highlight areas associated with lower survival (15,16).…”

Postoperative intracerebral haematomas following stereotactic biopsies: Poor planning or poor execution?

“…The present study controlled for patient‐related and methodological biases by selecting a homogeneous population of newly diagnosed supratentorial diffuse gliomas in adults who all underwent the same procedure of MRI‐based, robot‐assisted stereotactic serial biopsy sampling. We used preoperative MRI and early postoperative CT scans obtained as part of the daily clinical practice and we performed imaging normalization and co‐registrations with quality assessments, as previously described 26 …”

“…In order to assess the accuracy of the imaging data processing, we assessed the quality of the segmentation and of the spatial normalization by means of visual inspection by two evaluators blind to each other (AR and MZ), as previously reported 26 . In addition, we assessed the quality of the spatial normalization of the actual biopsy trajectory and of the bone‐based biopsy trajectory by superimposing them with surgically induced changes visible on the early postoperative CT scan.…”

“…In order to analyse the actual biopsy trajectory, we merged intraoperative 2D imaging with preoperative 3D imaging using a methodology previously detailed 26 and using homemade solutions. Institute, UTHSCSA, http://ric.uthscsa.edu/mango/).…”