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This article says that a gbm is not limited to the area of contrast enhancement. I have been saying over and over that we need things like Gliagen - the dye that lets a surgeon see where the tumor is during the operation. This article backs up the need.
Surg Neurol Int. 2012;3:158. Epub 2012 Dec 26.
Correlation between contrast enhancement on intraoperative magnetic resonance imaging and histopathology in glioblastoma.
Kubben PL, Wesseling P, Lammens M, Schijns OE, Ter Laak-Poort MP, van Overbeeke JJ, van Santbrink H.
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands.
Abstract
OBJECT:
Glioblastoma is a highly malignant brain tumor, for which standard treatment consists of surgery, radiotherapy, and chemotherapy. Increasing extent of tumor resection (EOTR) is associated with prolonged survival. Intraoperative magnetic resonance imaging (iMRI) is used to increase EOTR, based on contrast enhanced MR images. The correlation between intraoperative contrast enhancement and tumor has not been studied systematically.
METHODS:
For this prospective cohort study, we recruited 10 patients with a supratentorial brain tumor suspect for a glioblastoma. After initial resection, a 0.15 Tesla iMRI scan was made and neuronavigation-guided biopsies were taken from the border of the resection cavity. Scores for gadolinium-based contrast enhancement on iMRI and for tissue characteristics in histological slides of the biopsies were used to calculate correlations (expressed in Kendall's tau).
RESULTS:
A total of 39 biopsy samples was available for further analysis. Contrast enhancement was significantly correlated with World Health Organization (WHO) grade (tau 0.50), vascular changes (tau 0.53), necrosis (tau 0.49), and increased cellularity (tau 0.26). Specificity of enhancement patterns scored as "thick linear" and "tumor-like" for detection of (high grade) tumor was 1, but decreased to circa 0.75 if "thin linear" enhancement was included. Sensitivity for both enhancement patterns varied around 0.39-0.48 and 0.61-0.70, respectively.
CONCLUSIONS:
Presence of intraoperative contrast enhancement is a good predictor for presence of tumor, but absence of contrast enhancement is a bad predictor for absence of tumor. The use of gadolinium-based contrast enhancement on iMRI to maximize glioblastoma resection should be evaluated against other methods to increase resection, like new contrast agents, other imaging modalities, and "functional neurooncology" - an