MR evaluation of glioblastoma with triple-dose gadolinium-DO3A-butriol: Improved delineation of infiltrating tumour?

Purpose: To assess the efficacy of high-dose contrast enhanced magnetic resonance imaging (MRI) in detection and delineation of infiltrating tumour in glioblastoma. Material and methods: In a phase II clinical trial 14 patients with suspected supratentorial glioblastoma underwent MRI with Gd-DO3A-butriol (Gadovist(R), Schering AG, Berlin) with doses of 0.1 up to 0.3 mmol/kg. Results: Increasing the dose of Gd-DO3A-butriol resulted in improved enhancement (14/14) and better delineation of infiltrating tumour (9/14) up to 2 cm beyond enhancement after standard dose. In two of the 9 patients additional enhancement in the peritumoural oedema was only seen after the third injection. Conclusions: Successful surgery requires precise preoperative delineation of tumour borders. After high-dose MRI it might be possible to select those patients who would benefit from more radical attempts at eradicating the macroscopic as well as most of the microscopic compartment of glioblastoma.