Ajjikuttira Aiyapa A, Li Sarah, Haghighatpanah Mohammadreza, Sharma Pranav, Jeffree Rosalind, Roberts Jennie
Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, AUS.
Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, AUS.
Cureus. 2025 Sep 22;17(9):e92895. doi: 10.7759/cureus.92895. eCollection 2025 Sep.
Radiological differences exist between early-stage and late-stage glioblastoma (GBM). Most clinicians are aware of the latter appearances, but in our experience, early GBM (e-GBM) is often missed due to the absence of these classical findings. In this retrospective cohort study, we aim to highlight the radiological findings of e-GBM in order to improve recognition. This is important, as earlier recognition and treatment of this serious condition may improve prognosis.
A retrospective study of all patients presented at our institutional neuro-oncology multidisciplinary team meeting between 2012 and 2023 was undertaken. All patients had histologically confirmed GBM and early imaging that did not demonstrate the typical characteristics of malignant tumour. Imaging performed prior to the development of classical magnetic resonance imaging (MRI) features was reviewed by a single experienced neuroradiologist to investigate common imaging characteristics of e-GBM.
Thirty-four patients (21 male, 13 female) were included. All patients presented with neurological symptoms and underwent MRI, with 30 of 34 patients having gadolinium-enhanced MRI. On T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, all 34 patients had cortical signal change, while 33 of 34 patients had signal change in the subcortical region. All regions of FLAIR and T2 signal change demonstrated associated restricted diffusion. Thirty-two of 34 patients underwent computed tomography (CT) prior to MRI. Twenty-three of 32 patients had hyperdensity on CT correlating with areas of signal change on MRI.
e-GBM should be considered in patients presenting with neurological symptoms, in particular seizures, when T2WI or FLAIR signal abnormalities in a cortical or subcortical location are seen with associated restricted diffusion. Hyperdensity on non-contrast CT imaging congruent with areas of signal change on MRI should also prompt clinicians to consider e-GBM as a differential diagnosis.
早期和晚期胶质母细胞瘤（GBM）在放射学表现上存在差异。大多数临床医生熟悉后者的表现，但根据我们的经验，早期GBM（e-GBM）常因缺乏这些典型表现而被漏诊。在这项回顾性队列研究中，我们旨在突出e-GBM的放射学表现，以提高识别率。这一点很重要，因为对这种严重疾病的早期识别和治疗可能会改善预后。
对2012年至2023年间在我们机构的神经肿瘤多学科团队会议上就诊的所有患者进行回顾性研究。所有患者均经组织学确诊为GBM，且早期影像学检查未显示恶性肿瘤的典型特征。由一位经验丰富的神经放射科医生对在出现经典磁共振成像（MRI）特征之前进行的影像学检查进行回顾，以研究e-GBM的常见影像学特征。
纳入34例患者（男性21例，女性13例）。所有患者均有神经系统症状并接受了MRI检查，34例患者中有30例进行了钆增强MRI检查。在T2加权和液体衰减反转恢复（FLAIR）序列上，所有34例患者均有皮质信号改变，34例患者中有33例在皮质下区域有信号改变。FLAIR和T2信号改变的所有区域均显示相关的扩散受限。34例患者中有32例在MRI检查前进行了计算机断层扫描（CT）。32例患者中有23例CT上有高密度影，与MRI上信号改变区域相关。
当在皮质或皮质下位置出现T2WI或FLAIR信号异常并伴有相关扩散受限时，对于出现神经系统症状尤其是癫痫发作的患者，应考虑e-GBM。非增强CT成像上与MRI信号改变区域一致的高密度影也应促使临床医生将e-GBM作为鉴别诊断考虑。
