Assessing Glymphatic Function Alterations in Gliomas: DTI-ALPS as a Potential Biomarker for Tumor Characteristics and Survival Analysis.

Motivation: Researching the glymphatic system's role in brain fluid balance is essential for understanding brain tumor-induced homeostasis disruption and advancing treatment development. Goal(s): To evaluate the glymphatic function alterations associated with glioma by calculating DTI-ALPS and exploring its prognostic value. Approach: This study proposes a method for calculating DTI-ALPS in the contralateral cerebral hemisphere and utilizes statistical and machine learning techniques to evaluate glymphatic function in glioma. Results: Patients with highly invasive tumors (such as glioblastoma, IDH-wildtype, 1p19q-intact, complex edema shape and tumor texture) consistently exhibited reduced glymphatic function. DTI-ALPS combined with radiomic features improved survival prediction. Impact: This study emphasizes a significant connection between glymphatic function changes, tumor characteristics, and survival prognosis, providing a radiological basis for further neuro-oncological research on the glymphatic system.