The Utility of Spectroscopic MRI in Stereotactic Biopsy and Radiotherapy Guidance in Newly Diagnosed Glioblastoma

Simple Summary This report aims to demonstrate the value of spectroscopic MRI in glioma diagnostics and therapeutics planning. We first demonstrate clinical translatability by showing a biopsy case of a lower-grade glioma patient. The biopsy target was delineated via spectroscopy. Then, we conducted a secondary analysis of our clinical trial treating newly diagnosed glioblastoma (GBM) patients with belinostat by investigating the relationship between under-radiated tumor areas identified via spectroscopy and overall survival. Our results revealed that patients with a lower volume of undertreated tumors detected via spectroscopy had improved survival outcomes, highlighting the potential benefits of integrating metabolite information with treatment planning. Finally, we establish the utility of spectroscopic MRI for treating areas of future recurrence in patients with GBM. The report highlights the potential of advanced imaging techniques in improving the diagnostic and treatment strategies for this challenging disease.Abstract Current diagnostic and therapeutic approaches for gliomas have limitations hindering survival outcomes. We propose spectroscopic magnetic resonance imaging as an adjunct to standard MRI to bridge these gaps. Spectroscopic MRI is a volumetric MRI technique capable of identifying tumor infiltration based on its elevated choline (Cho) and decreased N-acetylaspartate (NAA). We present the clinical translatability of spectroscopic imaging with a Cho/NAA >= 5x threshold for delineating a biopsy target in a patient diagnosed with non-enhancing glioma. Then, we describe the relationship between the undertreated tumor detected with metabolite imaging and overall survival (OS) from a pilot study of newly diagnosed GBM patients treated with belinostat and chemoradiation. Each cohort (control and belinostat) were split into subgroups using the median difference between pre-radiotherapy Cho/NAA >= 2x and the treated T1-weighted contrast-enhanced (T1w-CE) volume. We used the Kaplan-Meier estimator to calculate median OS for each subgroup. The median OS was 14.4 months when the difference between Cho/NAA >= 2x and T1w-CE volumes was higher than the median compared with 34.3 months when this difference was lower than the median. The T1w-CE volumes were similar in both subgroups. We find that patients who had lower volumes of undertreated tumors detected via spectroscopy had better survival outcomes.