Individual data.

Relative cerebral maximum blood volume in the tumor (rCBVmax) significantly (p max values for every patient in the two subgroups and a red line indicating the mean (a). Missing correlations (Spearman’s rho = .12/.22) of the rCBVmax values at initial diagnosis and first progression in both subgroups displayed as scatter plots with regression lines (b and c). (TIF)</p

Patient and tumor characteristics (n = 65).

Patient and tumor characteristics (n = 65).</p

Vessel densities and corresponding rCBV_max in patients with available tumor tissue (n = 24).

Maximum vessel densities in the tumor (1/mm2, a) and corresponding relative cerebral maximum blood volume in the tumor (rCBVmax, b) significantly (p = .01/p 2, c) and the corresponding rCBVmax values (d) at initial diagnosis and first progression depicted as scatter plot with regression line.</p

rCBV_max at initial diagnosis and progression.

Relative cerebral maximum blood volume in the tumor (rCBVmax) significantly (p max values at initial diagnosis and first progression displayed as scatter plot with regression line (b).</p

Flow chart depicting the patient selection process.

The relatively large number of patients for whom MR-perfusion data were not available at at least one timepoint is mainly due to the fact that many patients had their follow-up MRI examinations performed at external facilities closer to their homes. (TIF)</p

Patient example.

MR-images and tumor tissue of an exemplary patient at initial diagnosis (first row) and first tumor progression (second row). T1-weighted contrast-enhanced images (a and d), cerebral blood volume (CBV) maps as transparent overlays on the T1-weighted contrast-enhanced images (b and e) and hematoxylin and eosin (HE) stained tumor tissue (c and f) are shown. Color bars in b and e display the CBV range. Arrows in c and f indicate exemplary vessels within the tumor. Both the CBV and the vessel density in the tumor were notably higher at the initial diagnosis in comparison to the first progression.</p

Ratios of tCho/NAA and concentrations of total Cho (tCho) for control and tumor tissue.

<p>Bars represent 95% confidence interval according to ANOVA. Closed symbols represent short-OS, open symbols long-OS.</p

Ratios for ³¹P lipid metabolite concentrations PCho/GPC and PEth/GPE for tumor and control tissue.

<p>Closed symbols represent short-OS, open symbols long-OS. * indicates p<0.05 level significance.</p

Representative PEth/GPE intensity map from a patient with recurrent GBM in the right parietooccipital lobe overlaid on the T2-weigthed anatomical slice before (upper line) and 8 weeks after starting BVZ therapy (lower line).

<p>The color scale specifies the levels of the PEth/GPE ratio of each ³¹P voxel, ranging from red for the highest ratios to blue for the lowest. To avoid unreasonable high values at very low GPE concentrations, the minimum GPE signal intensity was fixed at the accuracy for the data fitting procedure given by the ‘Cramer Rao Lower Bounds’ obtained from the jMRUI results table. Highest PEth/GPE ratios are found in the tumor area (area of high signal on the T2-w slice) of recurrent GBM which was decreased 8 under BZV. Representative ³¹P spectra from the tumor area (a) and from the normal-appearing tissue of the corresponding contralateral hemisphere (b) are shown in the right panels. Note that the PGE signal is almost absent whereas the PEth is prominent. Also note the decreased signal intensities of high-energy phosphates PCr and ATP in the tumor tissue compared to control.</p

Longitudinal changes in ethanolamine metabolites for tumor and control tissue.

<p>The upper rows show concentrations, the lower row the respective concentration ratios. For controls both ROIs (see Material and Methods) are shown with open symbols, the contralateral region with circles and solid lines, the temporal region (depicting ROI in the temporal region independent from tumor position) with squares and dashed lines. The data represent a subgroup with at least 110 days of progression free survival including patients with long-OS and short-OS (please note that 4 patients with long-OS still not had tumor progression).</p