{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:10:44Z","timestamp":1760148644813,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,5,21]],"date-time":"2023-05-21T00:00:00Z","timestamp":1684627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["U01 CA264039","F31 CA247564","R01 NS121544"],"award-info":[{"award-number":["U01 CA264039","F31 CA247564","R01 NS121544"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Accurate radiation therapy (RT) targeting is crucial for glioblastoma treatment but may be challenging using clinical imaging alone due to the infiltrative nature of glioblastomas. Precise targeting by whole-brain spectroscopic MRI, which maps tumor metabolites including choline (Cho) and N-acetylaspartate (NAA), can quantify early treatment-induced molecular changes that other traditional modalities cannot measure. We developed a pipeline to determine how spectroscopic MRI changes during early RT are associated with patient outcomes to provide insight into the utility of adaptive RT planning. Data were obtained from a study (NCT03137888) where glioblastoma patients received high-dose RT guided by the pre-RT Cho\/NAA twice normal (Cho\/NAA \u2265 2x) volume, and received spectroscopic MRI scans pre- and mid-RT. Overlap statistics between pre- and mid-RT scans were used to quantify metabolic activity changes after two weeks of RT. Log-rank tests were used to quantify the relationship between imaging metrics and patient overall and progression-free survival (OS\/PFS). Patients with lower Jaccard\/Dice coefficients had longer PFS (p = 0.045 for both), and patients with lower Jaccard\/Dice coefficients had higher OS trending towards significance (p = 0.060 for both). Cho\/NAA \u2265 2x volumes changed significantly during early RT, putting healthy tissue at risk of irradiation, and warranting further study into using adaptive RT planning.<\/jats:p>","DOI":"10.3390\/tomography9030086","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T03:57:32Z","timestamp":1684727852000},"page":"1052-1061","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Applying a Radiation Therapy Volume Analysis Pipeline to Determine the Utility of Spectroscopic MRI-Guided Adaptive Radiation Therapy for Glioblastoma"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3348-4529","authenticated-orcid":false,"given":"Anuradha G.","family":"Trivedi","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA"},{"name":"Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthik K.","family":"Ramesh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA"},{"name":"Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander S.","family":"Giuffrida","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA"},{"name":"Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7992-1747","authenticated-orcid":false,"given":"Brent D.","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA"},{"name":"Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric A.","family":"Mellon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 45056, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2473-2305","authenticated-orcid":false,"given":"Lawrence R.","family":"Kleinberg","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21218, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6410-7793","authenticated-orcid":false,"given":"Peter B.","family":"Barker","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21218, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Han","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Kuo G.","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA"},{"name":"Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyunsuk","family":"Shim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA"},{"name":"Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA"},{"name":"Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduard","family":"Schreibmann","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1056\/NEJMoa1308573","article-title":"A Randomized Trial of Bevacizumab for Newly Diagnosed Glioblastoma","volume":"370","author":"Gilbert","year":"2014","journal-title":"N. 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