Stripe-like increase of rCBV beyond the visible border of glioblastomas: site of tumor infiltration growing after neurosurgery

We observed a stripe-like pattern of regional cerebral blood volume (rCBV) increase in a defined region adjacent to the contrast enhancement (CE) on MRI of glioblastomas (GBM) that we defined as the striate sign (SS). We hypothesized that the SS marks infiltration of GBM outside the CE volume transforming into future CE tumor in the follow-up. T2*-weighted dynamic susceptibility-weighted CE (DSC)-MRI, and T1 and T2-weighted images (WI) of 16 patients with GBM were retrospectively evaluated in a baseline MRI performed before neurosurgery. In seven of these patients we also performed a (1)H MR spectroscopic imaging ((1)H MRSI). The regions of interest (ROI) delineating the SS were defined on rCBV maps for each patient. ROIs were overlaid on follow-up T1-WI and T2-WI MRI performed 3, 6, and 9 months after neurosurgery. Size and maximum signal intensity (max SI) of de novo CE within the area of the SS were analyzed. Statistical analysis was performed with the Friedman test (P < 0.05). In 15/16 patients de novo CE completely covered the area of the SS within nine months. Normalized max SI of de-novo CE of the 3, 6, and 9-months follow-up MR examinations were significantly higher than in the baseline MRI (P < 0.001). Normalized choline was increased within the SS in all patients with de novo CE (n = 6). De-novo CE appeared within the SS in all patients (96% of all slices). This implies that the SS might indicate the site of future CE tumor, which represents the area of tumor growth after neurosurgery.