Simple SummaryAfter treatment, glioblastoma typically recurs. In some patients with recurrent glioblastoma, bevacizumab improves progression-free survival. The magnetic resonance texture analysis quantifies the macroscopic tissue heterogeneity that is indirectly linked to the microscopic tissue properties. In 33 patients with recurrent glioblastoma who were treated with bevacizumab, we evaluated the predictive value of magnetic resonance texture analysis for survival. Volumes of contrast-enhancing lesions segmented on postcontrast T1-weighted sequences were co-registered with apparent diffusion coefficient maps in order to extract 107 radiomic features. We found that some features derived from texture analysis accurately predicted survival. Identifying pretreatment imaging biomarkers that predict outcomes following bevacizumab therapy for recurrent glioblastoma can be beneficial for selecting patients most likely to benefit from this costly treatment. These promising preliminary results may be a small but significant step toward demonstrating the clinical relevance of radiomic profiles in the treatment of this disease.AbstractPurpose: Glioblastoma often recurs after treatment. Bevacizumab increases progression-free survival in some patients with recurrent glioblastoma. Identifying pretreatment predictors of survival can help clinical decision making. Magnetic resonance texture analysis (MRTA) quantifies macroscopic tissue heterogeneity indirectly linked to microscopic tissue properties. We investigated the usefulness of MRTA in predicting survival in patients with recurrent glioblastoma treated with bevacizumab. Methods: We evaluated retrospective longitudinal data from 33 patients (20 men; mean age 56 ± 13 years) who received bevacizumab on the first recurrence of glioblastoma. Volumes of contrast-enhancing lesions segmented on postcontrast T1-weighted sequences were co-registered on apparent diffusion coefficient maps to extract 107 radiomic features. To assess the performance of textural parameters in predicting progression-free survival and overall survival, we used receiver operating characteristic curves, univariate and multivariate regression analysis, and Kaplan–Meier plots. Results: Longer progression-free survival (>6 months) and overall survival (>1 year) were associated with lower values of major axis length (MAL), a lower maximum 2D diameter row (m2Ddr), and higher skewness values. Longer progression-free survival was also associated with higher kurtosis, and longer overall survival with higher elongation values. The model combining MAL, m2Ddr, and skewness best predicted progression-free survival at 6 months (AUC 0.886, 100% sensitivity, 77.8% specificity, 50% PPV, 100% NPV), and the model combining m2Ddr, elongation, and skewness best predicted overall survival (AUC 0.895, 83.3% sensitivity, 85.2% specificity, 55.6% PPV, 95.8% NPV). Conclusions: Our preliminary analyses suggest that in patients with recurrent glioblastoma pretreatment, MRTA helps to predict survival after bevacizumab treatment.