The second case involved the use of perfusion parameters. For example, Jain  reported provocative results demonstrating a genomic basis for the commonly employed quantifiable perfusion parameters and gave impetus to implement this added knowledge into clinical practice. Integrating these quantitative perfusion parameters with the genomic markers in GBMs generated better prognostic models than either imaging or genomics could provide alone .
More recently, his group demonstrated that combining clinical, imaging, and genomic markers could also provide important and unique prognostic information about the poorly understood non-enhancing tumor regions in GBMs . The results, illustrated in Figure 3, demonstrated tumor infiltration beyond the contrast enhancing component and increased regional cerebral selleck chemical blood volume (rCBV) within the non-enhancing component.
Graphs of survival estimates demonstrated that rCBVNEL (CBV of the non-enhancing component) is a significant predictor of OS (log-rank AZD4547 order test, P= .0103) and progression-free survival (log-rank test, P= .0223), which also showed an association with wild-type EGFR mutation. The third case involved building gene expression-based models to predict triclocarban quantitative microscopic disease phenotypes. The potential advantage of using microscopic disease phenotypes (rather than patient survival) to supervise identification of biologically meaningful expression signatures is the presence
of multiple phenotypic targets per patient. For example, Brat et al. have used TCGA molecular data together with MR images within TCIA and whole slide pathology images to investigate molecular correlates of morphology in GBMs . To streamline glioma morphology-omics investigations using whole slide pathology images, they developed an end-to-end image analysis and data integration pipeline ,  and  and developed morphologic “signatures” from hundreds of millions of cells in digitized whole slide images. Using digitized images from TCGA GBM collection, three prognostically significant patient clusters were found based on biological functions of associated genes: cell cycle, chromatin modification, and protein biosynthesis clusters, as illustrated in Figure 4. Several cancer-related pathways were differentially enriched among the morphology clusters, including the ATM and TP53 DNA damage checkpoints, the NF-κB pathway, and the Wnt signaling and PTEN-AKT pathways. This analysis demonstrated the potential of high-throughput morphometrics to develop sub-classifications of the disease.