Fig. 3

Multimodal image-guided management in a PD-1, PD-L1, TILs glioblastoma. This case illustrates the potential interest of pre-immunotherapy immuno-PET imaging biomarkers since the immune escaping environment (i.e., pathology was negative for PD-1, PD-L1 and, tumor infiltrating lymphocytes) explaining the insensitivity of this patient to immunotherapy was demonstrated only on the pathology post-resection at the end of immunotherapy. Existing imaging techniques demonstrated treatment insensitivity (a–h) but were not able to decipher the immune contexture for an early prediction of outcome. Imaging of a patient with recurrent glioblastoma in the left parietal lobe treated with combined immunotherapy (nivolumab) and re-gamma knife. MRIs were obtained at 3-month intervals. a Baseline T1 post-contrast MRI prior to immunotherapy and re-gamma knife therapy demonstrating a 6 × 5 mm enhancing lesion in the left parietal lobe. b MRI post-initiation of immunotherapy and pre-re-gamma knife therapy showing interval growth of the lesion. c MRI perfusion demonstrating growth and increased flow along the anterior margin of the tumor. d, e PET/CT demonstrating continued growth and increased FDG activity along the margin of the lesion. f Subsequent MRI demonstrating significant growth, increased peripheral nodular enhancement, and central necrosis. g Post-contrast MRI post-resection showing mild non-specific enhancement around the resection margin. h Follow-up MRI 7 months after resection demonstrating progression of disease