Assessing and monitoring intratumor heterogeneity in glioblastoma: how far has multimodal imaging come?

Research output: Contribution to journalReview articlepeer-review


  • Natalie R Boonzaier
  • Sara G M Piccirillo
  • Colin Watts
  • Stephen J Price

Colleges, School and Institutes

External organisations

  • University of Cambridge
  • Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK.


Glioblastoma demonstrates imaging features of intratumor heterogeneity that result from underlying heterogeneous biological properties. This stems from variations in cellular behavior that result from genetic mutations that either drive, or are driven by, heterogeneous microenvironment conditions. Among all imaging methods available, only T1-weighted contrast-enhancing and T2-weighted fluid-attenuated inversion recovery are used in standard clinical glioblastoma assessment and monitoring. Advanced imaging modalities are still considered emerging techniques as appropriate end points and robust methodologies are missing from clinical trials. Discovering how these images specifically relate to the underlying tumor biology may aid in improving quality of clinical trials and understanding the factors involved in regional responses to treatment, including variable drug uptake and effect of radiotherapy. Upon validation and standardization of emerging MR techniques, providing information based on the underlying tumor biology, these images may allow for clinical decision-making that is tailored to an individual's response to treatment.


Original languageEnglish
Pages (from-to)399-410
Number of pages12
JournalCNS oncology
Issue number6
Early online date26 Oct 2015
Publication statusPublished - Dec 2015


  • Animals, Brain Neoplasms/pathology, Glioblastoma/pathology, Humans, Multimodal Imaging/methods, advanced imaging, intratumor heterogeneity, subregional assessment, underlying biology