Patients with glioblastoma multiforme (GBM) have extremely poor prognosis due to therapy resistance, aggressiveness, and poor understanding of pathophysiology. Here, we use APT-CEST and ASL MRI to noninvasively probe both pH and perfusion in ten patients with primary GBM, prior to surgical/therapeutic intervention. We observe an overall increase in APT and CBF contrast, consistent with both intracellular alkalosis and angiogenesis. Clustering analysis revealed a strong regional association between pH and CBF in 9/10 patients suggestive of similar spatial disruptions. The ability to image concomitant changes in pH and perfusion may provide a novel way to stratify patients for targeted therapeutics.
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