Multiparameter mri predictors of long-term survival in glioblastoma multiforme

Olya Stringfield, John A. Arrington, Sandra K. Johnston, Nicolas G. Rognin, Noah C. Peeri, Yoganand Balagurunathan, Pamela R. Jackson, Kamala R. Clark-Swanson, Kristin R. Swanson, Kathleen M. Egan, Robert A. Gatenby, Natarajan Raghunand

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Standard-of-care multiparameter magnetic resonance imaging (MRI) scans of the brain were used to objectively subdivide glioblastoma multiforme (GBM) tumors into regions that correspond to variations in blood flow, interstitial edema, and cellular density. We hypothesized that the distribution of these distinct tumor ecological “habitats” at the time of presentation will impact the course of the disease. We retrospectively analyzed initial MRI scans in 2 groups of patients diagnosed with GBM, a long-term survival group comprising subjects who survived 36 month postdiagnosis, and a short-term survival group comprising subjects who survived 19 month postdiagnosis. The single-institution discovery cohort contained 22 subjects in each group, while the multi-institution validation cohort contained 15 subjects per group. MRI voxel intensities were calibrated, and tumor voxels clustered on contrast-enhanced T1-weighted and fluid-attenuated inversion-recovery (FLAIR) images into 6 distinct “habitats” based on low-to medium-to high-contrast enhancement and low– high signal on FLAIR scans. Habitat 6 (high signal on calibrated contrast-enhanced T1-weighted and FLAIR sequences) comprised a significantly higher volume fraction of tumors in the long-term survival group (discovery cohort, 35% 6.5%; validation cohort, 34% - 4.8%) compared with tumors in the short-term survival group (discovery cohort, 17% - 4.5%, P - .03; validation cohort, 16 - 4.0%, P - .007). Of the 6 distinct MRI-defined habitats, the fractional tumor volume of habitat 6 at diagnosis was significantly predictive of long-or short-term survival. We discuss a possible mechanistic basis for this association and implications for habitat-driven adaptive therapy of GBM.

Original languageEnglish (US)
Pages (from-to)135-144
Number of pages10
Issue number1
StatePublished - Mar 2019


  • Cancer evolution
  • Glioblastoma
  • Habitats
  • MRI
  • Survival

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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