Diffusion and Perfusion Heterogeneity for Survival Stratification in Post-Treatment Glioblastoma

The study examined the prognostic value of diffusion and perfusion heterogeneity for overall survival in glioblastoma patients after treatment using a public MRI dataset. The research included 133 patients and analyzed 20 tumor features from diffusion (ADC) and perfusion (DSC) maps. Standard deviation of ADC (ADCstd) showed the strongest prognostic association with a hazard ratio of 1.56 and remained significant after clinical adjustment. Standard deviation of mean transit time (MTTstd) was the strongest perfusion marker with a hazard ratio of 1.38. Both metrics showed low correlation. The combined model incorporating clinical variables with ADCstd and MTTstd achieved significant improvement with a concordance index of 0.619. Diffusion heterogeneity represented a stronger imaging signal than perfusion heterogeneity, while the contribution of perfusion remained unproven.