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The preoperative prognostic value of tumor-specific CBF for subsequent enhancing tumor (ET) volume progression in gliomas remains poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this study 60 glioma patients (predominantly glioblastoma, WHO grade 4) with preoperative 3T ASL MRI and paired follow-up structural MRI were analyzed. Tumor CBF, surrounding CBF, and whole-brain CBF were quantified from the segmented regions of interest. ET and surrounding non-enhancing FLAIR-hyperintense (SNFH) volume changes were calculated and correlated with preoperative perfusion data. Spearman correlations, Kruskal-Wallis tests, multivariable linear and logistic regression, and ROC analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher preoperative tumor CBF strongly predicted net ET volume increase (Spearman\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.531,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and ET progression category (Kruskal-Wallis\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0005). Mean tumor CBF was 147.7\u00a0ml\/100\u00a0g\/min in ET-increased versus 124.4\u00a0ml\/100\u00a0g\/min in unchanged and 115.8\u00a0ml\/100\u00a0g\/min in decreased cases. Tumor CBF remained an independent predictor after adjusting for age, scan interval, and MGMT status (linear regression\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002; logistic regression OR\u2009=\u20092.02 per ml\/100\u00a0g\/min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Associations with SNFH volume changes were weak and non-significant. Surrounding CBF closely matched whole-brain CBF (Pearson\n                      <jats:italic>r<\/jats:italic>\n                      \u2009\u2248\u20091.00). Tumor CBF alone yielded 5-fold CV AUC\u2009=\u20090.805 for predicting ET progression; the combined model (tumor CBF\u2009+\u2009ET volume) improved to AUC\u2009=\u20090.858.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative ASL-derived tumor CBF appears to be an independent non-contrast imaging biomarker for early enhancing tumor progression risk in gliomas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12880-026-02612-9","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T14:34:52Z","timestamp":1785335692000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative tumor cerebral blood flow measured by arterial spin labeling predicts enhancing tumor volume progression in gliomas: a single-center retrospective study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4408-2429","authenticated-orcid":false,"given":"Thomas","family":"Lindner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Fiehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"2612_CR1","doi-asserted-by":"publisher","unstructured":"Ostrom QT, Price M, Ballard C, Benedetti J, Kruchko C, Barnholtz-Sloan JS. 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According to the institution that acquired the data, this retrospective, single-center, Health Insurance Portability and Accountability Act\u2013compliant study was undertaken with approval from the UCSF Institutional Review Board; a waiver for informed consent was granted.","order":1,"name":"Ethics","label":"Ethical approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"372"}}