Evidence map›Paper›PMID 41741374›Full record

ArticleNeuro-oncology2026

Automated delineation of putative non-contrast-enhancing tumor in glioblastoma: Prognostic insights.

Maria Gómez-Mahiques, Carles Lopez-Mateu, F Javier Gil-Terrón, Victor Montosa-I-Micó, Siri Fløgstad Svensson, Eduardo Erasmo Mendoza Mireles, Einar Osland Vik-Mo, Kyrre E Emblem, Carme Balañà-Quintero, Josep Puig and 7 more

Registry-linked trialAbstract readMulticenter Study
In one paragraph

Article in Neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03439332 (Multicentre Validation of Hemodynamic Multiparametric Tissue Signature), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03439332 completednot on this map

Multicentre Validation of Hemodynamic Multiparametric Tissue Signature (MTS) Biomarkers From Preoperative and Postradiotherapy MRI in Patients With Glioblastoma: Predictors of Overall Survival

TypeobservationalSponsorJuan M Garcia-GomezRan2018 to 2019Enrolled305ConditionsGlioblastoma
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Maria Gómez-MahiquesInstituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain.ORCID 0009-0003-7138-9340
Carles Lopez-MateuInstituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain.ORCID 0009-0006-5919-9335
F Javier Gil-TerrónInstituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain.ORCID 0000-0002-3536-6462
Victor Montosa-I-MicóInstituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain.ORCID 0009-0007-2216-9279
Siri Fløgstad SvenssonDepartment for Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.ORCID 0000-0002-6282-0341
Eduardo Erasmo Mendoza MirelesVilhelm Magnus Laboratory, Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.ORCID 0000-0002-3582-8014
Einar Osland Vik-MoVilhelm Magnus Laboratory, Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.ORCID 0000-0001-8303-4123
Kyrre E EmblemDepartment for Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.ORCID 0000-0002-6580-9519
Carme Balañà-QuinteroInstitut d'Investigació Germans Trias i Pujol, Barcelona, Spain.ORCID 0000-0003-0771-0390
Josep PuigDepartment of Radiology and IDIBAPS, Hospital Clínic de Barcelona, Barcelona, Spain.ORCID 0000-0003-2791-6599
Cristina AlendaPathology Department, Alicante Department of Health-General Hospital (C.A.).ORCID 0000-0002-0560-1759
Elena Martinez-SaezServicio de Anatomía Patológica, Hospital Universitari Vall d'Hebron, Barcelona, Spain.ORCID 0000-0001-6004-5364
Fran Martínez-RicarteServicio de Neurocirugía, Hospital Universitari Vall d'Hebron, Barcelona, Spain.ORCID 0000-0003-4567-0828
Marta Quirós-MartíServicio de Neurocirugía, Hospital Clínic Universitari de València, València, Spain.ORCID 0009-0008-2779-6818
Vicent Quilis-QuesadaServicio de Neurocirugía, Hospital Clínic Universitari de València, València, Spain.ORCID 0000-0001-8961-6896
Juan M García-GómezInstituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain.ORCID 0000-0002-3851-1557
Elies Fuster-GarciaInstituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain.ORCID 0000-0002-0716-8960

Funding

Agencia Valenciana de la Innovación INNEST/2022/87ECHIDNA PID2024-156848OB-I00ERDFEuropean Research Council 758657-ImPRESSFundació La Marató de TV3 665/C/2013Generalitat Valenciana CIAICO/2022/064Generalitat Valenciana INVEST/2022/298Helse Sør-Øst Regional Health Authority 2017073Helse Sør-Øst Regional Health Authority 2021057Instituto de Salud Carlos III PI18/01062LAB2OR MICIU/AEI/10.13039/501100011033LAB2OR PDC2025-165365-I00Research Council of Norway 261984Research Council of Norway 303249Research Council of Norway 32543Research Council of Norway 325971Spanish Ministry of Science, Innovation and Universities FPU23/02431Universitat Politècnica de València PAID-01-24Universitat Politècnica de València PID2021-127110OA-I00
6 · The paper itself

Abstract

backgroundPrecise delineation of non-contrast-enhancing tumor (nCET) in glioblastoma (GB) is critical for maximal safe resection, yet routine imaging cannot reliably separate infiltrative tumor from vasogenic edema. The aim of this study was to develop and validate an automated method to identify peritumoral subregions compatible with nCET and assess its prognostic value.

methodsPre-operative T2-weighted and FLAIR MRI from 940 patients with newly diagnosed GB in four multicenter cohorts were analyzed. A deep-learning model segmented enhancing tumor, edema and necrosis; a non-local, spatially varying finite mixture model was applied to identify edema subregions characterized by relatively lower FLAIR hyperintensity, hypothesized to reflect nCET-related tissue. The ratio of these subregions to total edema volume defined the T2/FLAIR Heterogeneity Index (TFHI). Associations between TFHI and overall survival (OS) were examined with Kaplan-Meier curves and multivariable Cox regression.

resultsHigher TFHI values stratified patients with shorter OS. In the NCT03439332, TFHI above the optimal threshold was associated with a twofold increased hazard of death (hazard ratio [HR] 2.07, 95 % confidence interval 1.33-3.21; P = .0013) and a reduction in median survival of 98 days. Significant, though smaller, prognostic effects were confirmed in GLIOCAT & BraTS (HR= 1.37; P = .047), OUS (HR = 1.37; P = .0032) and pooled analysis (HR= 1.26; P = .0008). TFHI remained an independent predictor after adjustment for age, extent of resection and MGMT methylation.

conclusionsWe present a reproducible, server-hosted tool for automated identification of imaging-defined, putative nCET-related peritumoral subregions and TFHI biomarker extraction that enables independent prognostic stratification. This approach provides a quantitative framework for studying peritumoral heterogeneity in GB.

Indexed as

Brain NeoplasmsGlioblastomaImage Processing, Computer-AssistedMagnetic Resonance ImagingAdultAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisSurvival Rateglioblastomanon-contrast-enhancing tumoroverall survivalsupramaximal resectionT2/FLAIR heterogeneity

Identifiers

PMID41741374
PMCPMC13231174

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.