The Direction of Tumour Growth in Glioblastoma Patients

Morteza Esmaeili,Anne Line Stensjøen,Ole Solheim,Ingerid Reinertsen,Erik Magnus Berntsen

doi:10.1038/s41598-018-19420-z

Morteza Esmaeili, Anne Line Stensjøen + Show 3 more

Open Access

https://doi.org/10.1038/s41598-018-19420-z

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Abstract

Generating MR-derived growth pattern models for glioblastoma multiforme (GBM) has been an attractive approach in neuro-oncology, suggesting a distinct pattern of lesion spread with a tendency in growing along the white matter (WM) fibre direction for the invasive component. However, the direction of growth is not much studied in vivo. In this study, we sought to study the dominant directions of tumour expansion/shrinkage pre-treatment. We examined fifty-six GBMs at two time-points: at radiological diagnosis and as part of the pre-operative planning, both with contrast-enhanced T1-weighted MRIs. The tumour volumes were semi-automatically segmented. A non-linear registration resulting in a deformation field characterizing the changes between the two time points was used together with the segmented tumours to determine the dominant directions of tumour change. To compute the degree of alignment between tumour growth vectors and WM fibres, an angle map was calculated. Our results demonstrate that tumours tend to grow predominantly along the WM, as evidenced by the dominant vector population with the maximum alignments. Our findings represent a step forward in investigating the hypothesis that tumour cells tend to migrate preferentially along the WM.

Highlights

Derived from glial cells, glioblastoma multiforme (GBM) is an extremely aggressive malignant brain tumour affecting adults
MR-derived growth pattern models for GBM have been developed as an attractive approach in neuro-oncology, as they have revealed a distinct pattern of lesion spread with growth tendency along the white fibre direction for the invasive component
Tumour measured in this study showed a tendency of moving along the white matter tracts, as evidenced by the dominant vector population with maximum alignments towards the tensor direction of the WM atlas (Fig. 3)

Summary

Introduction

Derived from glial cells, glioblastoma multiforme (GBM) is an extremely aggressive malignant brain tumour affecting adults. Large blood vessels characterized by very strong walls and dense tissues, such as cartilage, are harder for cancer cells to penetrate. This finding indicates that cancer cells grow along the path of least resistance, in line with most natural processes[13,14]. According to the generally accepted brain tumour development theory, tumour tends to grow along blood vessels or the white matter fibres, because of their anatomical characteristics, including a lubricated route for cancer cell migration[13,14]. MR-derived growth pattern models for GBM have been developed as an attractive approach in neuro-oncology, as they have revealed a distinct pattern of lesion spread with growth tendency along the white fibre direction for the invasive component. A significant correlation was found between MR-derived tumour location and prognosis, and/or the region-specific genetic profile of tumour cells[16,17,18]

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