15% of all brain tumors (~ 50% of all astrocytomas);
age after 40 years (peak 65-75 years);
aggressive, resistant to therapy with a poor prognosis;
primary glioblastomas (occur de novo ~ 90%),
secondary glioblastomas - develop from low grade gliomas (~ 10%).
usually large diffusely infiltrating masses of the cerebral hemispheres
have thick edges;
contrasted with a central zone of necrosis and a hemorrhagic component;
surrounded by edema of the vasogenic type with the content of tumor cells ("tumor + edema");
located more often supratentorial;
tendency to subcortical white matter and basal nuclei, as well as spread along the commissural tracts;
glioblastomas are multifocal in 20% of patients.
• solid component
• WHO IV (glioblastomas) = 745 ± 135 x 10-6mm 2/s
• WHO III (anaplastic astrocytomas) = 1067 ± 276 × 10-6mm 2/s
• WHO II (diffuse astrocytomas) = 1273 ± 293 x 10-6mm 2/s
MRI perfusion: rCBV is elevated compared to lower grade tumors and normal brain
↑ Cho, ↑ Lac, ↑ Lip, ↓ NAA ↓ Mio
PET shows FDG accumulation - increased glucose metabolism, more gray matter metabolism.
contrast enhancement pattern - crown effect
removal of the tumor, radiation therapy and chemotherapy.
monitoring is usually done within 24-48 hours after surgery (residual tissue assessment) and then every 8-12 weeks.