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Updated: Feb 17, 2026
In Vitro Assay to Study Tumor-macrophage Interaction
Published on: August 1, 2019
MR Imaging Characteristics Associate with Tumor-Associated Macrophages in Glioblastoma and Provide an Improved
J Zhou1,2, M V Reddy3, B K J Wilson3
1From the Departments of Radiology (J.Z., M.V.R., B.K.J.W.) jean.zhou@southerndhb.govt.nz.
Background And Purpose:
In glioblastoma, tumor-associated macrophages have tumor-promoting properties. This study determined whether routine MR imaging features could predict molecular subtypes of glioblastoma that differ in the content of tumor-associated macrophages.
Materials And Methods:
Seven internally derived MR imaging features were assessed in 180 patients, and 25 features from the Visually AcceSAble Rembrandt Images feature set were assessed in 164 patients. Glioblastomas were divided into subtypes based on the telomere maintenance mechanism: alternative lengthening of telomeres positive (ALT+) and negative (ALT-) and the content of tumor-associated macrophages (with [M+] or without [M-] a high content of macrophages). The 3 most frequent subtypes (ALT+/M-, ALT-/M+, and ALT-/M-) were correlated with MR imaging features and clinical parameters. The fourth group (ALT+/M+) did not have enough cases for correlation with MR imaging features.
Results:
Tumors with a regular margin and those lacking a fungating margin, an expansive T1/FLAIR ratio, and reduced ependymal extension were more frequent in the subgroup of ALT+/M- (P < .05). Radiologic necrosis, lack of cystic component (by both criteria), and extensive peritumoral edema were more frequent in ALT-/M+ tumors (P < .05). Multivariate testing with a Cox regression analysis found the cystic imaging feature was additive to tumor subtype, and O6-methylguanine methyltransferase (MGMT) status to predict improved patient survival (P < .05).
Conclusions:
Glioblastomas with tumor-associated macrophages are associated with routine MR imaging features consistent with these tumors being more aggressive. Inclusion of cystic change with molecular subtypes and MGMT status provided a better estimate of survival.
Insights
Routine MR imaging features can predict glioblastoma subtypes associated with tumor-associated macrophages. These imaging features, along with molecular subtypes and O6-methylguanine methyltransferase status, help estimate patient survival.
Area of Science:
- Neuro-oncology
- Radiology
- Molecular Pathology
Background:
- Glioblastoma (GBM) is an aggressive brain tumor.
- Tumor-associated macrophages (TAMs) in GBM promote tumor growth.
- Predicting GBM subtypes with distinct TAM content is crucial.
Purpose of the Study:
- To determine if routine MR imaging features can predict molecular subtypes of glioblastoma.
- To correlate these subtypes with tumor-associated macrophage content.
Main Methods:
- Assessed 7 internal and 25 Visually AcceSAble Rembrandt Images (VISCAR) MR imaging features in 180 and 164 patients, respectively.
- Classified glioblastomas into subtypes based on telomere maintenance mechanism (alternative lengthening of telomeres positive [ALT+] or negative [ALT-]) and TAM content (high [M+] or low [M-]).
- Correlated 3 frequent subtypes (ALT+/M-, ALT-/M+, ALT-/M-) with MR imaging and clinical parameters.
Main Results:
- ALT+/M- tumors showed regular margins, lacked fungating margins, had an expansive T1/FLAIR ratio, and reduced ependymal extension.
- ALT-/M+ tumors exhibited radiologic necrosis, lacked cystic components, and had extensive peritumoral edema.
- Multivariate analysis revealed cystic change and O6-methylguanine methyltransferase (MGMT) status predict improved survival.
Conclusions:
- Routine MR imaging features correlate with glioblastoma subtypes characterized by varying TAM content.
- These imaging features suggest more aggressive tumor behavior in TAM-rich glioblastomas.
- Integrating cystic change, molecular subtypes, and MGMT status improves survival prediction in glioblastoma.
