Multiparametric MRI to stratify risk factors for hemorrhagic complications in inoperable glioblastomas following stereotactic needle biopsy.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-09-01 Epub Date: 2025-09-16 DOI:10.1007/s00234-025-03769-w

Matia Martucci, Claudia Tocilă-Mătășel, Luigi Ruscelli, Giuseppe Varcasia, Giammaria Marziali, Francesco Schimperna, Giovanni Pentassuglia, Amato Infante, Quintino Giorgio D'Alessandris, Alessandro Olivi, Simona Gaudino

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引用次数: 0

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

查看原文本刊更多论文

立体定向针活检后不能手术的胶质母细胞瘤出血并发症的多参数MRI分层危险因素。

目的：胶质母细胞瘤（GB）的组织学确认对于治疗计划至关重要，即使在不能手术的情况下，立体定向针活检（STNB）是唯一的选择。然而，手术后出血仍然是一个已知的风险。本研究旨在评估GB的MRI特征与STNB后出血并发症之间的关系。方法：本回顾性单中心研究纳入了78例idh -野生型GB患者（平均年龄61岁，女性33例），这些患者在72小时内进行了活检前MRI（包括SWI和dsc灌注）和活检后CT检查。病变根据其位置解剖分为四组：皮质/浅表灰质（sGM n = 12），室管膜下白质（sWM n = 36），深核/丘脑（n = 26），或脑干（n = 4）。出血发生率和面积与病变部位、瘤内易感信号（ITSS）分级、rCBVmax值及瘤周水肿相关。同时记录临床结果。结果：不同部位出血发生率差异有统计学意义（p = 0.009），其中深部出血发生率最高（85%）。大多数非出血性病例（53%）发生在sWM。rCBVmax与出血发生率无相关性，但与出血面积呈显著线性相关（p = 0.016, r = 0.331）。3级ITSS病变表现为更广泛的出血。肿瘤周围水肿与出血无相关性。大多数出血无症状；只有两名患者出现了短暂的神经系统症状。结论：病变位置是活检后出血的最强预测因子。rCBVmax与出血风险之间没有相关性，这表明即使在高灌注（可能更具侵袭性）的肿瘤区域也可以安全地进行活检。在术前评估和术后监测适当的情况下，STNB仍然是一种安全而有价值的诊断工具。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.