Radio-pathomic signatures within and beyond FLAIR hyperintensity predict prognosis in glioblastoma following gross total resection

Motivation: Glioblastoma (GBM), a highly lethal brain tumor, poses a significant threat to patient survival, even after gross total resection (GTR). Goal(s): This study explored whether radio-pathomic features from autopsy-trained models could predict survival in GTR-treated GBM patients. Approach: The relationship between cell density and tumor probability (TPM) beyond the FLAIR hyperintense (FH) region, as well as a habitat-based labeling within FH was investigated. Cox regressions evaluated the impact of habitat volume and radio-pathomic characteristics within FH on survival. Results: The study revealed that radio-pathomic features of FH predicted overall survival, suggesting the ability to identify infiltrative tumor ultimately missed by surgery. Impact: In GTR-treated GBM patients, the presence of infiltrative tumor cells within and beyond FLAIR hyperintensity may predict patient prognosis and could be used for optimizing treatment.