尽管对磁共振成像 (MRI) 定义的对比增强 (CE) 中央肿瘤区域进行了最大程度的安全切除并进行了放化疗，但大多数胶质母细胞瘤 (GBM) 患者在一年内会在瘤周 FLAIR 区域复发。磁共振波谱成像 (MRSI) 可以区分具有较高复发潜力的代谢肿瘤区域，因为 CNI 区域（胆碱/N-乙酰天冬氨酸指数 >2）可以预测复发部位。由于复发主要归因于胶质母细胞瘤干样细胞 (GSC)，因此 CNI 区域可能富含 GSC。在这项前瞻性试验中，16 名 GBM 患者在手术/放化疗前接受了 MRSI/MRI，以调查来自 CE/FLAIR 的 CNI-/活检中的 GSC 含量。活检和衍生 GSC 表征揭示了 FLAIR/CNI 样本在 GSC 以及与干性、DNA 修复、粘附/迁移和线粒体生物能学相关的基因特征中富集。 FLAIR/CNI 样本比 FLAIR/CNI 样本更快地生成富含 GSC 的神经球。 FLAIR/CNI 中评估活检 GSC 含量和神经球形成时间的参数与患者预后较差相关。术前 MRI/MRSI 肯定可以更好地切除和靶向 FLAIR/CNI 区域，因为它们的 GSC 富集可以预测更糟糕的结果。

Despite maximally safe resection of the magnetic resonance imaging (MRI)-defined contrast-enhanced (CE) central tumor area and chemoradiotherapy, most patients with glioblastoma (GBM) relapse within a year in peritumoral FLAIR regions. Magnetic resonance spectroscopy imaging (MRSI) can discriminate metabolic tumor areas with higher recurrence potential as CNI+ regions (choline/N-acetyl-aspartate index >2) can predict relapse sites. As relapses are mainly imputed to glioblastoma stem-like cells (GSCs), CNI+ areas might be GSC enriched. In this prospective trial, 16 patients with GBM underwent MRSI/MRI before surgery/chemoradiotherapy to investigate GSC content in CNI-/+ biopsies from CE/FLAIR. Biopsy and derived-GSC characterization revealed a FLAIR/CNI+ sample enrichment in GSC and in gene signatures related to stemness, DNA repair, adhesion/migration, and mitochondrial bioenergetics. FLAIR/CNI+ samples generate GSC-enriched neurospheres faster than FLAIR/CNI-. Parameters assessing biopsy GSC content and time-to-neurosphere formation in FLAIR/CNI+ were associated with worse patient outcome. Preoperative MRI/MRSI would certainly allow better resection and targeting of FLAIR/CNI+ areas, as their GSC enrichment can predict worse outcomes.