Whole-brain spectroscopic MRI biomarkers identify infiltrating margins in glioblastoma patients

James S. Cordova, Hui Kuo G. Shu, Zhongxing Liang, Saumya S. Gurbani, Lee Alex Donald Cooper, Chad A. Holder, Jeffrey J. Olson, Brad Kairdolf, Eduard Schreibmann, Stewart G. Neill, Constantinos G. Hadjipanayis, Hyunsuk Shim*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

67 Scopus citations


Background The standard of care for glioblastoma (GBM) is maximal safe resection followed by radiation therapy with chemotherapy. Currently, contrast-enhanced MRI is used to define primary treatment volumes for surgery and radiation therapy. However, enhancement does not identify the tumor entirely, resulting in limited local control. Proton spectroscopic MRI (sMRI), a method reporting endogenous metabolism, may better define the tumor margin. Here, we develop a whole-brain sMRI pipeline and validate sMRI metrics with quantitative measures of tumor infiltration. Methods Whole-brain sMRI metabolite maps were coregistered with surgical planning MRI and imported into a neuronavigation system to guide tissue sampling in GBM patients receiving 5-aminolevulinic acid fluorescence-guided surgery. Samples were collected from regions with metabolic abnormalities in a biopsy-like fashion before bulk resection. Tissue fluorescence was measured ex vivo using a hand-held spectrometer. Tissue samples were immunostained for Sox2 and analyzed to quantify the density of staining cells using a novel digital pathology image analysis tool. Correlations among sMRI markers, Sox2 density, and ex vivo fluorescence were evaluated. Results Spectroscopic MRI biomarkers exhibit significant correlations with Sox2-positive cell density and ex vivo fluorescence. The choline to N-acetylaspartate ratio showed significant associations with each quantitative marker (Pearson's ρ = 0.82, P <. 001 and ρ = 0.36, P <. 0001, respectively). Clinically, sMRI metabolic abnormalities predated contrast enhancement at sites of tumor recurrence and exhibited an inverse relationship with progression-free survival. Conclusions As it identifies tumor infiltration and regions at high risk for recurrence, sMRI could complement conventional MRI to improve local control in GBM patients.

Original languageEnglish (US)
Pages (from-to)1180-1189
Number of pages10
Issue number8
StatePublished - Aug 1 2016


  • 5-aminolevulinic acid
  • Glioblastoma
  • Quantitative histological image analysis
  • Spectroscopic MRI
  • Surgical and radiation therapy planning

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research


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