2026/02/06 by Minchul Kim, Min Seo Choi, Inpyeong Hwang +3
Medicine · Neuroscience · #Advanced Neuroimaging Techniques and Applications #Cerebrospinal fluid and hydrocephalus #Glioma Diagnosis and Treatment
paper · pdf · doi:10.1007/s00234-026-03928-7
crossref issued 2026/02/06 · crossref published 2026/02/06 · crossref published-online 2026/02/06 · openalex publication_date 2026/02/06 · crossref created 2026/02/06 · openalex created_date 2026/02/07 · crossref published-print 2026/07/01 · openalex updated_date 2026/07/31 · crossref deposited 2026/07/31 · crossref indexed 2026/07/31
PURPOSE: Diffusion MRI-based indirect indices of neurofluid dynamics, such as diffusion tensor imaging along the perivascular space (DTI-ALPS) and extracellular free water (FW), have been reported to have prognostic implications in glioblastoma. However, their clinical utility, replicability, and the relation between the tumor burden remain insufficiently investigated with inconsistent results hindering its integration into routine imaging. METHODS: Two datasets of isocitrate dehydrogenase-wildtype (IDHwt) glioblastoma were retrieved from The Cancer Imaging Archive (UPENN = 200, UCSF = 125). The automated DTI-ALPS (aDTI-ALPS) and the FW index was used as an indirect indicator of glymphatic function. Prognostic significance was assessed using Kaplan-Meier analysis along with log-rank test, and multivariable Cox regression including aDTI-ALPS and clinical variables such as age, and extent of resection. Associations between MRI indices and tumor characteristics were also evaluated. RESULTS: A higher aDTI-ALPS index was associated with longer survival (P = 0.024 and 0.018 for both datasets, respectively; log-rank test), indicating its prognostic significance. Multivariable Cox analysis revealed low aDTI-ALPS as an independent factor for poor prognosis (hazard ratio (HR), 1.352; P = 0.050 and hazard ratio, 1.616; P = 0.044, respectively). Low FW index was associated with longer survival in UPENN. Additionally, the aDTI-ALPS index showed no correlation with tumor volume or tumor laterality, and the HR was smaller than molecular markers. CONCLUSION: Automated DTI-ALPS and the free water index may serve as reproducible prognostic factors in IDH-wildtype glioblastoma, while showing no significant correlation with tumor burden.