Deciphering glioblastoma: Unveiling imaging markers for predicting MGMT promoter methylation status

Glioblastoma, the most common primary malignant tumor of the central nervous system in adults, is also among the most lethal. Despite a comprehensive treatment approach which utilizes surgery and postoperative chemoradiation, prognosis typically remains dismal. However certain epigenetic modifications, such as methylation of the MGMT promoter, have been proven to correlate with improved post-treatment outcomes. The 2021 WHO classification emphasizes molecular characteristics, highlighting shared genomic alterations across different grades and positioning MGMT methylation as a key influencer of outcomes. A combined diagnostic approach involving current imaging technology and emerging radiomics and deep learning models may allow for timely and accurate prediction of MGMT methylation status and therefore earlier and more individualized treatment and prognostication. Though these advanced radiomics models are rapidly emerging, additional development, standardization, and implementation may lead to a higher and more individualized level of patient care. This review explores the potential of imaging features in predicting MGMT promoter methylation, a critical determinant of therapeutic response and patient outcomes.