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Transl Oncol. 2017 Dec;10(6):895-903. doi: 10.1016/j.tranon.2017.08.009. Epub 2017 Sep 22.

Characterization of Metabolic, Diffusion, and Perfusion Properties in GBM: Contrast-Enhancing versus Non-Enhancing Tumor.

Author information

1
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA. Electronic address: adam.autry@ucsf.edu.
2
Department of Pathology, University of California, San Francisco, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
3
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
4
Helen Diller Family Comprehensive Cancer Center (HDFCC) Biostatistical Core Facility, University of California, San Francisco, San Francisco, CA, USA; Computational Biology Core, University of California, San Francisco, San Francisco, CA, USA.
5
Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Biostatistics and Epidemiology, University of California, San Francisco, San Francisco, CA, USA.
6
Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
7
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA.

Abstract

BACKGROUND:

Although the contrast-enhancing (CE) lesion on T1-weighted MR images is widely used as a surrogate for glioblastoma (GBM), there are also non-enhancing regions of infiltrative tumor within the T2-weighted lesion, which elude radiologic detection. Because non-enhancing GBM (Enh-) challenges clinical patient management as latent disease, this study sought to characterize ex vivo metabolic profiles from Enh- and CE GBM (Enh+) samples, alongside histological and in vivo MR parameters, to assist in defining criteria for estimating total tumor burden.

METHODS:

Fifty-six patients with newly diagnosed GBM received a multi-parametric pre-surgical MR examination. Targets for obtaining image-guided tissue samples were defined based on in vivo parameters that were suspicious for tumor. The actual location from where tissue samples were obtained was recorded, and half of each sample was analyzed for histopathology while the other half was scanned using HR-MAS spectroscopy.

RESULTS:

The Enh+ and Enh- tumor samples demonstrated comparable mitotic activity, but also significant heterogeneity in microvascular morphology. Ex vivo spectroscopic parameters indicated similar levels of total choline and N-acetylaspartate between these contrast-based radiographic subtypes of GBM, and characteristic differences in the levels of myo-inositol, creatine/phosphocreatine, and phosphoethanolamine. Analysis of in vivo parameters at the sample locations were consistent with histological and ex vivo metabolic data.

CONCLUSIONS:

The similarity between ex vivo levels of choline and NAA, and between in vivo levels of choline, NAA and nADC in Enh+ and Enh- tumor, indicate that these parameters can be used in defining non-invasive metrics of total tumor burden for patients with GBM.

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