NIMG-51. IMPACT ON REMOTE FUNCTIONAL AREAS DUE TO TUMOR MASS EFFECT IS PROGNOSTIC OF OVERALL SURVIVAL IN GLIOBLASTOMA MULTIFORME

Neurological deficits and seizures due to intra-cranial pressure (ICP) exerted from the growing tumor and associated mass effect are one of the first clinical symptoms in Glioblastoma Multiforme (GBM). However, little is known about the specific functional areas that are impacted due to increased ICP within the confined cranial vault, and the role of this impact in overall patient outcome. In this work, we hypothesized that deformation due to tumor mass effect in eloquent and functional areas of the brain perhaps leads to increased neurological deficits, resulting in poor patient outcome. We measured the deformation in remote brain areas due to GBM mass effect based on the laterality of the primary tumors on a total of 89 GBM subjects (48 left-sided tumors, 41 right-sided tumors) from T1w MRI. The T1w MRI images were non-rigidly registered to a normal atlas to measure the tissue deformations surrounding the tumor. The distribution of deformation within each of the functionally eloquent areas of the brain was correlated with the length of overall survival (mean: 469.83 ± 397.31 days). Survival (mean: 469.83 ± 397.31 days) time was highly associated (R>-0.40, p<0.05) with the deformation in both left and right temporal gyri, post-central gyri, olfactory and insular cortices and right supra-marginal gyrus, for the tumors of the right hemisphere. As mass effect can deform regions in contra-lesional hemisphere, the negative impact of deformation on survival was therefore observed across both hemispheres in areas known for language comprehension, social cognition, visual perception, and emotion, somato-sensory, cognitive and motor-control functions. The study findings suggest that the increased deformation in remote functional areas due to mass effect was correlated with decreased overall survival perhaps due to neurological deficits. Once validated on a larger cohort, these findings could provide insights into the palliative therapy and management of GBM patients.