Histopathological and molecular characteristics of IDH-wildtype glioblastoma without contrast enhancement: implications for clinical outcomes
Glioblastoma (GB) heterogeneity poses substantial challenges for diagnosis and treatment. Isocitrate dehydrogenase (IDH)-wildtype GB may lack contrast enhancement on MRI and exhibit a “low-grade radiologic appearance” (non-contrast-enhancing [CE] GB), a phenomenon with unclear clinical implications....
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| Hauptverfasser: | , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
July 2025
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| In: |
Neuro-Oncology
Year: 2025, Jahrgang: 27, Heft: 7, Pages: 1878-1887 |
| ISSN: | 1523-5866 |
| DOI: | 10.1093/neuonc/noaf070 |
| Online-Zugang: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1093/neuonc/noaf070 Verlag, lizenzpflichtig, Volltext: https://academic.oup.com/neuro-oncology/article/27/7/1878/8087448 
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| Verfasserangaben: | Martha Foltyn-Dumitru, Rouzbeh Banan, Marianne Schell, Mustafa Ahmed Mahmutoglu, Tobias Kessler, Wolfgang Wick, Gianluca Brugnara, Martin Bendszus, Felix Sahm, and Philipp Vollmuth |
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| 520 | |a Glioblastoma (GB) heterogeneity poses substantial challenges for diagnosis and treatment. Isocitrate dehydrogenase (IDH)-wildtype GB may lack contrast enhancement on MRI and exhibit a “low-grade radiologic appearance” (non-contrast-enhancing [CE] GB), a phenomenon with unclear clinical implications. This study investigates the histopathological and molecular differences and survival outcomes between CE and non-CE GB.This retrospective study at Heidelberg University Hospital analyzed 457 IDH-wildtype GB cases (09/2009-01/2021). Contrast enhancement on preoperative MRI was volumetrically assessed, classifying tumors as non-CE/CE GB using a 1 cm³ cutoff. Molecular and histopathological features, including microvascular proliferation, necrosis, and overall survival (OS), were compared between the groups.Of the initial cohort, 352 (77%) patients met the inclusion criteria, with 44 (12.5%) non-CE and 308 (87.5%) CE GB. The histopathological assessment revealed that non-CE GB was less likely to present traditional hallmarks of GB, such as microvascular proliferation (39% vs. 94%) and necrosis (25% vs. 92%) (P < .001). In the non-CE group, 24 patients (55%) were diagnosed as molecular GB, compared to only 8 patients (3%) in the CE group (P < .001). A significant difference was observed in Ki-67 levels, with non-CE GBs having a lower mean Ki-67 index of 18% ± 12% compared to 26% ± 13% in CE tumors (P < .001). The median OS was 27.2 months (95% CI, 19.8-NA) for non-CE and 14.7 months (95% CI, 13.2-17.1) for CE GB (P = .0049).IDH-wildtype GBs without contrast enhancement are often diagnosed based on molecular criteria due to less frequent histopathological hallmarks and are associated with prolonged OS. | ||
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