Glioblastoma without Remarkable Contrast Enhancement on Magnetic Resonance Imaging


This is the report of a histological and clinical investigation of 4 cases of glioblastoma, a rare tumor, in whom poor contrast enhancement of the tumor was visualized on magnetic resonance imaging (MRI). Among the 94 patients with first-occurrence glioblastoma treated between January 2000 and August 2011, 4 were enrolled in this retrospective study. There were 2 men and 2 women, ranging in age from 41 to 70 years (mean, 57 years). All the patients underwent tumor resection, postoperative irradiation, and chemotherapy. One died of local tumor recurrence after 36 months; the remaining three remain alive as of 25 to 72 months after the initial treatment. The histopathology was glioblastoma with nuclear pleomorphism and pseudopalisading necrosis in all cases. However, the typical vascular endothelial proliferation was not found in 3 cases. All glioblastomas were immunopositive for p53 and immunonegative for epidermal growth factor receptor (EGFR) and isocitrate dehydrogenase 1 (IDH1). These glioblastomas showing unclear contrast enhancement on MRI had similar clinical and pathological characteristics, but differed in characteristics from glioblastoma patients showing marked contrast enhancement of the tumor on MRI.

Share and Cite:

S. Utsuki, H. Oka, Y. Miyajima, C. Kijima, Y. Yasui and K. Fujii, "Glioblastoma without Remarkable Contrast Enhancement on Magnetic Resonance Imaging," International Journal of Clinical Medicine, Vol. 3 No. 6, 2012, pp. 439-445. doi: 10.4236/ijcm.2012.36082.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. Pierallini, M. Bonamini, A. Bozzao, P. Pantano, D. D. Stefano, E. Ferone, M. Raguso, C. Bosman and L. Bozzao, “Supratentorial Diffuse Astrocytic Tumours: Proposal of an MRI Classification,” European Radiology, Vol. 7, No. 3, 1997, pp. 395-399. doi:10.1007/s003300050173
[2] L. M. DeAngelis, “Brain Tumors,” New England Journal of Medicine, Vol. 344, No. 2, 2001, pp. 114-123. doi:10.1056/NEJM200101113440207
[3] F. J. Wippold, M. Lammle, F. Anatelli, J. Lennerz and A. Perry, “Neuropathology for the Neuroradiologist: Palisades and Pseudopalisades,” American Journal of Neuroradiology, Vol. 27, No. 10, 2006, pp. 2037-2041.
[4] L. E. Bohman, K. R. Swanson, J. L. Moore, R. Rockne, C. Mandigo, T. Hankinson, M. Assanah, P. Canoll and J. N. Bruce, “Magnetic Resonance Imaging Characteristics of Glioblastoma Multiforme: Implications for Understanding Glioma Ontogeny,” Neurosurgery, Vol. 67, No. 5, 2010, pp. 1319-1328. doi:10.1227/NEU.0b013e3181f556ab
[5] R. Ramakrishna, J. Barber, G. Kennedy, A. Rizvi, R. Goodkin, R. H. Winn, G. A. Ojemann, M. S. Berger, A. M. Spence and R. C. Rostomily, “Imaging Features of Invasion and Preoperative and Postoperative Tumor Burden in Previously Untreated Glioblastoma: Correlation with Survival,” Surgical Neurology International, Vol. 1, 2010, p. 40.
[6] A. A. Cohen-Gadol, M. L. DiLuna, S. I. Bannykh, J. M. Piepmeier and D. D. Spencer, “Non-Enhancing de Novo Glioblastoma: Report of Two Cases,” Neurosurgical Review, Vol. 27, No. 4, 2004, pp. 281-285. doi:10.1007/s10143-004-0346-5
[7] J. Moore-Stovall and R. Venkatesh, “Serial Nonenhancing Magnetic Resonance Imaging Scans of High Grade Glioblastoma Multiforme,” Journal of the National Medical Association, Vol. 85, No. 2, 1993, pp. 122-128.
[8] W. B. Pope, J. Sayre, A. Perlina, J. A. Villablanca, P. S. Mischel, T. F. Cloughesy, et al., “MR Imaging Correlates of Survival in Patients with High-Grade Gliomas,” American Journal of Neuroradiology, Vol. 26, No. 10, 2005, pp. 2466-2474.
[9] C. Zimmer, V. Ivancevic, R. Klingebiel, K. P. Wandinger and F. K. H. van Landeghem, “Advanced Brain Tumor Imaging in Unusual Non-Enhancing Malignant Gliomas,” Klinsche Neuroradiologie, Vol. 13, No. 2, 2003, pp. 88-91.
[10] S. Utsuki, H. Oka, Y. Miyajima, C. Kijima, Y. Yasui and K. Fujii, “Adult Cerebellar Glioblastoma Cases Have Different Characteristics from Supratentorial Glioblastoma,” Brain Tumor Pathology, Vol. 29, No. 2, 2012, pp. 87-95.
[11] L. T. Masters and R. D. Zimmerman, “Imaging of Supratentorial Brain Tumors in Adults,” Neuroimaging Clinics of North America, Vol. 3, 1993, pp. 649-687.
[12] L. E. Ginsberg, G. N. Fuller, M. Hashmi, N. E. Leeds and D. F. Schomer, “The Significance of Lack of MR Contrast Enhancement of Supratentorial Brain Tumors in Adults: Histopathological Evaluation of a Series,” Surgical Neurology, Vol. 49, No. 4, 1998, pp. 436-440. doi:10.1016/S0090-3019(97)00360-1
[13] D. Kondziolka, L. D. Lunsford and A. J. Martinez, “Unreliability of Contemporary Neurodiagnostic Imaging in Evaluating Suspected Adult Supratentorial (Low-Grade) Astrocytoma,” Journal of Neuro-surgery, Vol. 79, No. 4, 1993, pp. 533-536. doi:10.3171/jns.1993.79.4.0533
[14] M. J. Perez-Cruet, L. Adelman, M. Anderson, P. A. Roth, A. M. Ritter and S. C. Saris, “CT-Guided Stereotactic Biopsy of Nonenhancing Brain Lesions,” Stereotactic and Functional Neurosurgery, Vol. 61, No. 3, 1993, pp. 105-117. doi:10.1159/000100629
[15] M. C. Chamberlain, J. A. Murovic and V. A, Levin, “Absence of Contrast Enhancement on CT Brain Scans of Patients with Supratentorial Malignant Gliomas,” Neurology, Vol. 38, No. 9, 1988, pp. 1371-1374. doi:10.1212/WNL.38.9.1371
[16] M. Castillo, “Contrast Enhancement in Primary Tumors of the Brain and Spinal Cord,” Neuroimaging Clinics of North America, Vol. 4, No. 1, 1994, pp. 63-80.
[17] L. D. Recht, R. Lew and T. W. Smith, “Suspected Low-Grade Glioma: Is Deferring Treatment Safe?” Annals of Neurolpgy, Vol. 31, No. 4, 1992, pp. 431-436. doi:10.1002/ana.410310413
[18] R. Nagata, K. Ikeda, Y. Nakamura, Y. Ishikawa, K. Miura, R. Sato, Y. Kawase, K. Kawabe and Y. Iwasaki, “A Case of Gliomatosis Cerebri Mimicking Limbic Encephalitis: Malignant Transformation to Glioblastoma,” Internal Medicine, Vol. 49, No. 13, 2010, pp. 1307-1310. doi:10.2169/internalmedicine.49.3278
[19] G. J. Felsberg, S. A. Silver, M. T. Brown and R. D. Tien, “Radiologic-Pathologic Correlation. Gliomatosis Cerebri,” American Journal of Neuroradiology, Vol. 15, No. 9, 1994, pp. 1745-1753.
[20] Y. M. Shin, K. H. Chang, M. H. Han, N. H. Myung, J. G. Chi, S. H. Cha and M. C. Han, “Gliomatosis Cerebri: Comparison of MR and CT Features,” American Journal of Radiology, Vol. 161, No. 4, 1993, pp. 859-862.
[21] J. Piepmeier, S. Christopher, D. Spencer, T. Byrne, J. Kim, J. P. Knisel, J. Lacy, L. Tsukerman and R. Makuch, “Variations in the Natural History and Survival of Patients with Supratentorial Lowgrade Astrocytomas,” Neurosurgery, Vol. 38, No. 5, 1996, pp. 872-879. doi:10.1097/00006123-199605000-00002
[22] D. Afra, E. Osztie, L. Sipos and D. Vitanovics, “Preoperative History and Postoperative Survival of Supratentorial Low-Grade Astrocytomas,” British Journal of Neurosurgery, Vol. 13, No. 3, 1999, pp. 299-305. doi:10.1080/02688699943727
[23] H. Ohgaki and P. Kleihues, “Genetic Pathways to Primary and Secondary Glioblastoma,” American Journal of Pathology, Vol. 170, No. 5, 2007, pp. 1445-1453. doi:10.2353/ajpath.2007.070011
[24] K. Kawarabuki, T. Ohta, N. Hashimoto, K. Wada, M. Maruno, T. Yamaki and S. Ueda, “Cerebellar Glioblastoma Genetically Defined as a Secondary One,” Clinical Neuropathology, Vol. 24, No. 2, 2005, pp. 64-68.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.