Spatial comparison of MR perfusion and radio-pathomic model derived cell density in newly diagnosed glioma patients: prognostic implications

Motivation: Deliniating non-angiogenic and early-angiogenic areas of tumor prevents detection of the full extent of glioblastoma invasion. Goal(s): This study investigated the relationship between perfusion and radio-pathomic estimates of cell density in glioblastoma. Approach: This study compared ASL- and DSC-based perfusion estimates to predicted cellularity maps in two large publicly available datasets. Results: Positive cellularity-perfusion associations were observed within contrast enhancement but not in non-enhancing regions. Per-subject positive cellularity-perfusion associations within FLAIR hyperintensity were associated with worse prognosis in glioblastoma patients following gross total resection. Impact: Areas of increased perfusion and hypercellularity can be used to direct surgical intervention to capture early-angiogenic areas of tumor missed by contrast enhancement, which may in turn improve survival outcomes. Non-angiogenic hypercellular tumor may persist outside even this margin.