Directional interface mechanics using magnetic resonance elastography predicts focal tumor recurrence in glioblastomas

Glioblastoma progression is spatially heterogeneous, but conventional imaging provides limited information about where subsequent tumor progression is likely to occur. We developed a directional magnetic resonance elastography (MRE) framework to test whether local post-treatment tumor–brain interface mechanics are associated with later spatial tumor progression. In a secondary analysis of a prospectively acquired glioblastoma cohort, wedge-level viscoelastic instability features were extracted from the first post-treatment MRE scan and related to novel tumor burden on the second post-treatment scan after excluding tumor already present on pretreatment or first post-treatment imaging. Nine patients had longitudinal imaging suitable for spatial comparison; six lesions showed net interval growth and were included in the primary wedge-level directional analysis, while three non-growing lesions were retained for descriptive comparison. In growing lesions, several directional mechanical features were descriptively associated with later novel tumor burden. In cluster-aware models accounting for within-patient dependence among wedges, mean Δtanδ showed the most consistent association with later wedge-level novel tumor fraction across mixed-effects and generalized estimating equation analyses. Associations were directionally stable across wedge-width sensitivity analyses. These findings provide proof of principle that post-treatment glioblastoma interface mechanics contain spatially resolved information related to where later tumor emergence occurs, supporting further validation of directional MRE as a framework for longitudinal mapping of progression geometry.