New Diffusion Restriction Precedes the Development of Enhancing Tumor in Glioblastomas

Ajay Gupta^1,2, Sahil Sood^1,2, Robert Young², Sasan Karimi², Zhigang Zhang², Andrei Holodny²

Assessment of glioma progression vs. stability or response has traditionally relied on typical MR imaging characteristics, such as changes in tumor size and extent of contrast enhancement. Finding earlier imaging biomarkers of glioma progression can have an enormous impact on clinical treatment decision-making. In this study, we demonstrate that in a subset of patients with GBM, new nonenhancing regions of restricted diffusion can predict the future development of enhancing tumor and tumor progression. This information may therefore be useful in guiding clinical decision making and treatment changes prior to the development of abnormal tumoral enhancement.