Preop DSC-MRI perfusion (CBV/CBF) predicts poorer survival in high-grade glioma despite 96% EOR with iMRI

Preoperative MR perfusion (DSC-MRI CBV/CBF) and intraoperative MRI (iMRI) were evaluated in a prospective, single-center pilot cohort of newly diagnosed high-grade glioma (WHO grade 3 astrocytoma + glioblastoma; n=14; 3 IDH1/2-mutant, 11 IDH1/2–wild-type) treated 2/15/2017–11/29/2019. Higher preoperative CBV and CBF correlated with worse OS (p<0.05), while iMRI perfusion was difficult to quantify and did not clearly track outcomes; mean extent of resection was 96±5% with no EOR difference between “good” vs “poor” survival groups (split by median OS 10 months). Patients in the better-outcome group had OS 27±15 months (p=0.002) and PFS 21±20 months (p=0.05); by comparison, newly diagnosed glioblastoma treated with RT+temozolomide has historically shown median OS ~14.6 months (with modern trial control arms often closer to ~19–20 months), underscoring how strongly tumor biology and case-mix can dominate survival even when EOR is high.