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Updated: Jun 27, 2026

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Post-Treatment MRI Features on First Follow-Up Imaging in Diffuse Gliomas After Near-Total Resection: A Real-World

Teodor Cristian Blidaru1, Dan Mitrea2, Nicolae Dragoș Garofil1

  • 1Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu 37, 020021 Bucharest, Romania.

Medicina (Kaunas, Lithuania)
|June 26, 2026
PubMed
Summary

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Residual tumor on first post-treatment MRI, along with postoperative functional status, predicts recurrence-free survival in diffuse glioma patients after near-total resection. These findings highlight key prognostic imaging markers for clinical practice.

Area of Science:

  • Neuro-oncology
  • Radiology
  • Medical Imaging

Background:

  • Magnetic resonance imaging (MRI) is crucial for diffuse glioma monitoring post-treatment.
  • Prognostic value of early post-treatment MRI findings is not fully established in routine care.
  • Near-total resection (NTR) is defined as ≥80% volumetric tumor removal.

Purpose of the Study:

  • To assess if MRI features on the first post-treatment scan correlate with recurrence-free survival (RFS) after NTR.
  • To investigate the association between imaging findings and RFS in a real-world diffuse glioma cohort.

Main Methods:

  • Included 139 adult patients with diffuse gliomas (2021-2024) classified by 2021 WHO CNS criteria.
  • Analyzed the earliest follow-up MRI (mean ~120 days post-surgery) after all planned therapy.
Keywords:
brain tumor recurrencediffuse gliomaimaging biomarkersmagnetic resonance imagingnear-total resectionneuro-oncologypostoperative imagingreal-world cohortresidual tumor

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  • Used logistic regression to link post-treatment MRI features with 1- and 2-year RFS after NTR.

    • Main Results:

    • Residual tumor on first post-treatment MRI was linked to lower RFS at 1 and 2 years.
    • Postoperative functional status independently predicted tumor control.
    • Other imaging variables showed associations in univariable but not multivariable analyses.

    Conclusions:

    • Residual tumor on early follow-up MRI is a strong imaging correlate of reduced RFS in diffuse gliomas.
    • Postoperative functional status is also an independent predictor of tumor control.
    • Findings require validation in prospective, stratified studies.