Multilayer Structure and Progression Patterns by Motility Phenotypes.

<p>Virtual magnetic resonance imaging of simulations showing the multilayer structure of GBM for the three motility phenotypes: (a) Highly Dispersive, (b) Moderately Dispersive, and (c) Hypoxia Driven. 1% of the brain with detectable vascular proliferation (purple arrows) or radiological necrosis (pink arrows) served as triggers for detection of each GBM. In all three cases, the tumors progressed to the appearance of a necrotic core (pink arrows) surrounded by a proliferating ring (orange arrows). Death was triggered by either 20% tumor mass or 5% radiological necrosis. Treatment of these tumors reproduced progression by Expanding FLAIR (d), Expanding FLAIR + Necrosis (e), and Expanding Necrosis (f). For the treated tumors, the first time shot (treatment) is taken immediately prior to anti-angiogenesis treatment, the second time shot shows the 2-month or 3-month follow-up, and the final time shot displays tumor appearance at the simulated time of death. In progression by Expanding FLAIR (d), treatment effectively eliminates the spread of tumor with vascular proliferation (purple arrows) while low-density tumor cells, or FLAIR (green arrows) continue to invade the brain. Both (e) and (f) also show a reduction in the spread of vascular tumor. However, for moderately dispersive tumors (e), treatment results in progression by Expanding FLAIR (green arrow) + Expanding Necrosis (pink arrow). Treated hypoxia-driven tumors (f) progress by Expanding Necrosis alone (pink arrow), where the area of low-density invasive tumor hovers just beyond the periphery of the necrotic core.