Reliable brain tumor imaging can be ambiguous to distinguish true progression from treatment effect.  Furthermore, inaccurate identification of tumor progression might result in continuation of ineffective treatment or premature discontinuation of effective therapies.  This is an active topic in neuro-oncology as it applies to patient care and standardization of imaging techniques.  Improved tumor imaging surveillance tools that supplement current standards and allow earlier detection of progression can improve clinician confidence and patient outcomes.

In 2018 a projected 79,000 persons in the US will be diagnosed with a primary brain tumor.  Glioblastoma (GBM) is the deadliest and most common of these tumors in adults with overall survival ~15 mos and >93% of patients deceased by 5-years.  Disease progression is inevitable, and effective second-line therapies are few.  Delays in identifying progressed GBM risks neurologic decline and increased tumor mutations that potentially renders treatment less-effective. 

This study collected 560 WHO grade IV astrocytomas with gross-total-resection within our institution between 2006 and 2017 to evaluate changes in T2/FLAIR signal intensity, diffusion restriction, and contrast enhancement both in and around the resection cavity to determine earliest indicators of tumor progression.  This is an early data release of an ongoing retrospective study with encouraging findings that support a novel combination of radiographic biomarkers as early indicators of GBM progression using routine brain tumor imaging. 

Thus far, 125 cases screened have demonstrated previously reported signal intensity changes within the resection cavity as well as specific phenomena that have not been previously described, such as FLAIR migration and FLAIR coring timed closely with radiographic progression. 

The proposed technique does not require advanced brain tumor imaging and can therefore be readily standardized in clinical practice.   With further validation, this novel combination of imaging features might serve to supplement existing response criteria in GBM surveillance.