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A significant challenge in Glioblastoma (GBM) management is identifyingpseudo-progression (PsP), a benign radiation-induced effect, from tumorrecurrence, on routine imaging following conventional treatment. Previousstudies have linked tumor lobar presence and laterality to GBM outcomes,suggesting that disease etiology and progression in GBM may be impacted bytumor location. Hence, in this feasibility study, we seek to investigate thefollowing question: Can tumor location on treatment-na\"ive MRI provide earlycues regarding likelihood of a patient developing pseudo-progression versustumor recurrence? In this study, 74 pre-treatment Glioblastoma MRI scans withPsP (33) and tumor recurrence (41) were analyzed. First, enhancing lesion onGd-T1w MRI and peri-lesional hyperintensities on T2w/FLAIR were segmented byexperts and then registered to a brain atlas. Using patients from the twophenotypes, we construct two atlases by quantifying frequency of occurrence ofenhancing lesion and peri-lesion hyperintensities, by averaging voxelintensities across the population. Analysis of differential involvement wasthen performed to compute voxel-wise significant differences (p-value<0.05)across the atlases. Statistically significant clusters were finally mapped to astructural atlas to provide anatomic localization of their location. Ourresults demonstrate that patients with tumor recurrence showed prominence oftheir initial tumor in the parietal lobe, while patients with PsP showed amulti-focal distribution of the initial tumor in the frontal and temporallobes, insula, and putamen. These preliminary results suggest thatlateralization of pre-treatment lesions towards certain anatomical areas of thebrain may allow to provide early cues regarding assessing likelihood ofoccurrence of pseudo-progression from tumor recurrence on MRI scans.

Can tumor location on pre-treatment MRI predict likelihood of pseudo-progression versus tumor recurrence in Glioblastoma? A feasibility study