Unveiling intratumoral heterogeneity and isocitrate dehydrogenase status in gliomas: a simultaneous fluorine-18 fluorodeoxyglucose PET/MRI study based on 2021 WHO classification

Simultaneous 18F-FDG PET/MRI provides complementary metabolic and functional information for glioma characterization. When intratumoral heterogeneity is accounted for using GEE, perfusion parameters emerge as robust biomarkers for predicting high-grade histology and IDH-wt status. These findings support a multimodal approach to guide stereotactic biopsies to the most aggressive intratumoral foci.