ArticleNeuro-oncology2026
Contralateral neurofluid dynamics predict survival in IDH wild-type glioblastoma: A DTI-ALPS and free water imaging study.
Article in Neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Glymphatic system dysfunction in central nervous system malignancies: A narrative review.Neurosurgical review · 2026Review
- Diffusion tensor image analysis along the perivascular space (DTI-ALPS): redefining its interpretation and role.Japanese journal of radiology · 2026Review
- DTI-ALPS is not independently associated with overall survival beyond established prognostic factors in glioblastoma.Journal of neuro-oncology · 2026Article
- Validation of automated DTI-ALPS and free water index as potential survival stratification markers in IDH-wildtype glioblastoma.Neuroradiology · 2026Article
- Putative glymphatic dysfunction links extracellular fluid dysregulation to white matter degeneration and clinical impairment in amyotrophic lateral sclerosis.BMC medicine · 2026Article
- ASL perfusion radiomic heterogeneity is associated with early mortality in IDH-wildtype glioblastoma, beyond tumor volume: a time-varying effect with tumor-aware DTI-ALPS.Frontiers in oncology · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
15 authors.
Funding
Abstract
backgroundGlioblastoma (GBM) may disrupt glymphatic function and neurofluid dynamics locally and in distant brain regions. However, the prognostic relevance of such alterations remains unclear. We investigated whether diffusion tensor image analysis along the perivascular space (DTI-ALPS) and free water (FW) imaging serve as biomarkers of glymphatic dysfunction and survival in patients with IDH wild-type GBM.
methodsWe retrospectively analyzed preoperative MRI data from 277 patients in the UPENN-GBM and 269 patients in the UCSF-PDGM cohorts. The ALPS index was quantified in tumor regions and normal-appearing white matter (NAWM) in both hemispheres, and the FW volume fraction in the contralateral NAWM. Data harmonization was performed using ComBat to adjust for intersite variability. Survival analyses were conducted using log-rank tests and Cox regression models. Optimal ALPS index and FW thresholds were derived from the UPENN-GBM dataset and validated in the UCSF-PDGM.
resultsThe ALPS index was significantly lower in tumor regions than NAWM (P < .01). In the contralateral hemisphere of the UPENN-GBM cohort, a lower ALPS index and higher FW in NAWM were independently associated with shorter overall survival (HR = 0.75, P = .027 for ALPS index; HR = 1.34, P = .04 for FW). The identified thresholds successfully stratified survival in UPENN-GBM and were validated in UCSF-PDGM (P = .011 for ALPS; P = .038 for FW).
conclusionsNeurofluid dynamic alterations in the contralateral hemisphere, assessed using DTI-ALPS and FW imaging, were independently associated with survival in patients with IDH wild-type GBM. These findings support the use of glymphatic imaging markers for prognostic stratification and therapeutic targeting.
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