Patients with recurrent glioblastoma (rGBM) are often started on anti-angiogenic therapy, making it challenging to determine disease progression with standard MR methods. We performed a prospective analysis on 14 patients with rGBM utilizing MR spectroscopy and DSC-perfusion imaging to investigate metabolic changes before and 4 weeks after anti-angiogenic therapy. We found that anti-angiogenic therapy significantly decreases relative tumor hyperperfusion values of CBV and CBF and uncouples a correlation between CBV and CBF with Lac/c-Cr. Baseline hyperperfusion values can stratify longer-term from shorter-term survivors at nine months. Further investigation into the early stages of anti-angiogenic therapy are warranted.
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