Martucci Matia, Tocilă-Mătășel Claudia, Ruscelli Luigi, Varcasia Giuseppe, Marziali Giammaria, Schimperna Francesco, Pentassuglia Giovanni, Infante Amato, D'Alessandris Quintino Giorgio, Olivi Alessandro, Gaudino Simona
Advanced Radiology Center (ARC), Department of Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Neuroradiology. 2025 Sep 16. doi: 10.1007/s00234-025-03769-w.
Histological confirmation of glioblastoma (GB) is essential for therapeutic planning, even in inoperable cases where stereotactic needle biopsy (STNB) is the only option. However, post-procedural bleeding remains a known risk. This study aimed to evaluate the association between MRI features of GB and hemorrhagic complications following STNB.
This retrospective, single-center study included 78 patients with IDH-wildtype GB (mean age: 61 years; 33 females) who underwent pre-biopsy MRI (including SWI and DSC-perfusion) and post-biopsy CT within 72 h. Lesions were anatomically classified into four groups based on their location: cortical/superficial grey matter (sGM n = 12), subependymal white matter (sWM; n = 36), deep nuclei/thalamus (n = 26), or brainstem (n = 4). Hemorrhage incidence and area were correlated with lesion location, intratumoral susceptibility signal (ITSS) grade, rCBVmax values, and peritumoral edema. Clinical outcomes were also recorded.
Hemorrhage incidence significantly differed by lesion location (p = 0.009), with the highest frequency in deep lesions (85%). Most non-hemorrhagic cases (53%) occurred in sWM. While rCBVmax did not correlate with hemorrhage incidence, a significant linear association with hemorrhage area was noted (p = 0.016, r = 0.331). Grade 3 ITSS lesions showed more extensive bleeding. No correlation was found between peritumoral edema and bleeding. Most hemorrhages were asymptomatic; only two patients experienced transient neurological symptoms.
Lesion location was the strongest predictor of post-biopsy hemorrhage. The absence of correlation between rCBVmax and bleeding risk suggests biopsies can be safely performed even in hyperperfused (and potentially more aggressive) tumor areas. STNB remains a safe and valuable diagnostic tool when appropriate preoperative evaluation and postoperative monitoring are ensured.
胶质母细胞瘤（GB）的组织学确诊对于治疗方案的制定至关重要，即便在无法手术的病例中，立体定向针吸活检（STNB）是唯一选择时亦是如此。然而，术后出血仍是一个已知风险。本研究旨在评估GB的MRI特征与STNB术后出血并发症之间的关联。
这项回顾性单中心研究纳入了78例异柠檬酸脱氢酶（IDH）野生型GB患者（平均年龄：61岁；33例女性），这些患者在活检前接受了MRI检查（包括磁敏感加权成像（SWI）和动态对比增强灌注成像（DSC）），并在72小时内接受了活检后CT检查。根据病变位置，将病变在解剖学上分为四组：皮质/浅表灰质（sGM，n = 12）、室管膜下白质（sWM；n = 36）、深部核团/丘脑（n = 26）或脑干（n = 4）。出血发生率和面积与病变位置、瘤内易感性信号（ITSS）分级、最大相对脑血容量（rCBVmax）值以及瘤周水肿相关。还记录了临床结局。
出血发生率因病变位置而异（p = 0.009），深部病变中的发生率最高（85%）。大多数无出血病例（53%）发生在sWM。虽然rCBVmax与出血发生率无关，但与出血面积存在显著的线性关联（p = 0.016，r = 0.331）。3级ITSS病变显示出更广泛的出血。未发现瘤周水肿与出血之间存在关联。大多数出血无症状；仅有两名患者出现短暂的神经症状。
病变位置是活检后出血的最强预测因素。rCBVmax与出血风险之间缺乏相关性表明，即使在高灌注（且可能更具侵袭性）的肿瘤区域也可安全地进行活检。当确保进行适当的术前评估和术后监测时，STNB仍然是一种安全且有价值的诊断工具。
