MRI necrosis morphology predicts survival after chemoradiation in glioblastoma

Patients with a low-risk (compact) necrosis phenotype on post-chemoradiation MRI had nearly three-fold lower hazard of death (HR 0.35, p=0.001), independent of tumor volume, MGMT status, age, and KPS.

• Low-risk necrosis was more compact with smoother margins, greater volume, fewer isolated clusters, lower perfusion, and higher oxygen extraction on advanced MRI.
• The imaging phenotype remained an independent predictor after multivariable adjustment (adjusted HR 0.29, p=0.001).

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