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Purpose <p>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.</p> Methods <p>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&#xa0;h. Lesions were anatomically classified into four groups based on their location: cortical/superficial grey matter (sGM <i>n</i> = 12), subependymal white matter (sWM; <i>n</i> = 36), deep nuclei/thalamus (<i>n</i> = 26), or brainstem (<i>n</i> = 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.</p> Results <p>Hemorrhage incidence significantly differed by lesion location (<i>p</i> = 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 (<i>p</i> = 0.016, <i>r</i> = 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.</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月16日

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  • 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

摘要

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.