Multiparametric MRI Predicts Longitudinal Changes in Telomerase Activity in Recurrent IDH-Wildtype Glioblastoma

Motivation: Telomerase activity, crucial in glioblastoma recurrence, is an emerging therapeutic target. Non-invasive prediction methods are needed. Goal(s): This study aims to predict telomerase activity changes in recurrent IDH-wildtype glioblastoma using multiparametric MRI, focusing on rCBV/ADC ratios. Approach: In 24 patients, MRI radiomics and habitat analysis of tumor regions were compared with telomerase activity from ELISA, evaluated via logistic regression and AUROC. Results: Higher rCBV/ADC ratios and increased hypovascularity and T2-FLAIR heterogeneity correlated with reduced telomerase activity (AUROC: 0.847). Impact: Tumor habitat analysis using multiparametric MRI for noninvasive telomerase activity prediction could inform telomerase-targeted clinical trials in glioblastoma treatment.