Open Access 14-04-2025 | Glioblastoma | Research

Advanced imaging characterization of post-chemoradiation glioblastoma stratified by diffusion MRI phenotypes known to predict favorable anti-VEGF response

Authors: Francesco Sanvito, Irina Kryukov, Jingwen Yao, Ashley Teraishi, Catalina Raymond, John Gao, Cole Miller, Phioanh L. Nghiemphu, Albert Lai, Linda M. Liau, Kunal Patel, Richard G. Everson, Blaine S.C. Eldred, Robert M. Prins, David A. Nathanson, Noriko Salamon, Timothy F. Cloughesy, Benjamin M. Ellingson

Published in: Journal of Neuro-Oncology

Abstract

Purpose

Recurrent glioblastomas showing a survival benefit from anti-VEGF agents are known to exhibit a distinct diffusion MRI phenotype. We aim to characterize advanced imaging features of this glioblastoma subset.

Methods

MRI scans from 87 patients with IDH-wildtype glioblastoma were analyzed. All patients had completed standard chemoradiation and were anti-VEGF-naïve. Contrast-enhancing tumor segmentations were used to extract: the lowest peak of the double gaussian distribution of apparent diffusion coefficient values (ADC_L) calculated from diffusion MRI, relative cerebral blood flow (rCBV) values from perfusion MRI, MTR_asym @ 3ppm from pH-weighted amine CEST MRI, quantitative T₂ and T₂* relaxation times (qT₂ and qT₂*), T₁w subtraction map values, and contrast-enhancing tumor volume. Lesions were categorized as high- or low-ADC_L using a cutoff of 1240 µm²/s, according to previous studies.

Results

High-ADC_L lesions showed significantly lower rCBV (1.02 vs. 1.28, p = 0.0057), higher MTR_asym @ 3ppm (2.36% vs. 2.10%, p = 0.0043), and higher qT₂ (114.8 ms vs. 100.9 ms, p = 0.0094), compared to low-ADC_L lesions. No group differences were seen in contrast-enhancing tumor volume, T₁w subtraction map values, and qT₂*, nor in clinical variables such as sex category, MGMT status, and EGFR status. Finally, no clear group-specific preferential locations were seen.

Conclusion

Post-chemoradiation glioblastomas with a diffusion MRI phenotype that is known to predict a favorable response to anti-VEGF (ADC_L ≥1240 µm²/s) have distinct biological features, with different perfusion and metabolic characteristics, and T₂ relaxation times.

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Title: Advanced imaging characterization of post-chemoradiation glioblastoma stratified by diffusion MRI phenotypes known to predict favorable anti-VEGF response
Authors: Francesco Sanvito
Irina Kryukov
Jingwen Yao
Ashley Teraishi
Catalina Raymond
John Gao
Cole Miller
Phioanh L. Nghiemphu
Albert Lai
Linda M. Liau
Kunal Patel
Richard G. Everson
Blaine S.C. Eldred
Robert M. Prins
David A. Nathanson
Noriko Salamon
Timothy F. Cloughesy
Benjamin M. Ellingson
Publication date: 14-04-2025
Publisher: Springer US
Keywords: Glioblastoma
Glioblastoma
Glioblastoma
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Bevacizumab
Published in: Journal of Neuro-Oncology
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-025-05019-8

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