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@ARTICLE{FoltynDumitru:300832,
      author       = {M. Foltyn-Dumitru and R. Banan and M. Schell and M. A.
                      Mahmutoglu and T. Kessler$^*$ and W. Wick$^*$ and G.
                      Brugnara$^*$ and M. Bendszus and F. Sahm$^*$ and P.
                      Vollmuth$^*$},
      title        = {{H}istopathological and molecular characteristics of
                      {IDH}-wildtype glioblastoma without contrast enhancement:
                      implications for clinical outcomes.},
      journal      = {Neuro-Oncology},
      volume       = {27},
      number       = {7},
      issn         = {1522-8517},
      address      = {Oxford},
      publisher    = {Oxford Univ. Press},
      reportid     = {DKFZ-2025-00943},
      pages        = {1878-1887},
      year         = {2025},
      note         = {#LA:E230# / 2025 Sep 8;27(7):1878-1887},
      abstract     = {Glioblastoma (GB) heterogeneity poses substantial
                      challenges for diagnosis and treatment. IDH-wildtype GB may
                      lack contrast enhancement on MRI and exhibit a 'low-grade
                      radiologic appearance' (non-CE GB), a phenomenon with
                      unclear clinical implications. This study investigates the
                      histopathological and molecular differences and survival
                      outcomes between contrast-enhancing (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
                      cut-off. 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
                      glioblastoma, such as microvascular proliferation $(39\%$
                      vs. $94\%)$ and necrosis $(25\%$ vs. $92\%)$ (p<0.001). In
                      the non-CE group, 24 patients $(55\%)$ were diagnosed as
                      molecular-GB, compared to only 8 patients $(3\%)$ in the CE
                      group (p < 0.001). 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<0.001). 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=0.0049).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.},
      keywords     = {IDH-wildtype glioblastoma (Other) / MRI (Other) /
                      contrast-enhancement (Other) / histopathology (Other) /
                      low-grade radiologic appearance (Other)},
      cin          = {B320 / E230 / B300 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)B320-20160331 / I:(DE-He78)E230-20160331 /
                      I:(DE-He78)B300-20160331 / I:(DE-He78)HD01-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40108725},
      doi          = {10.1093/neuonc/noaf070},
      url          = {https://inrepo02.dkfz.de/record/300832},
}