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The microvessels area (MVA), derived from microvascular proliferation, is a biomarker useful for highgrade glioma classifcation. Nevertheless, its measurement is costly, labor-intense, and invasive. Finding radiologic cor‑ relations with MVA could provide a complementary non-invasive approach without an extra cost and labor intensity and from the first stage. | Álvarez Torres et al. BMC Cancer 2022 22 40 https doi.org 10.1186 s12885-021-09117-4 RESEARCH ARTICLE Open Access Local detection of microvessels in IDH- wildtype glioblastoma using relative cerebral blood volume an imaging marker useful for astrocytoma grade 4 classification María del Mar Álvarez Torres1 Elies Fuster García2 Javier Juan Albarracín1 Gaspar Reynés3 Fernando Aparici Robles4 Jaime Ferrer Lozano5 and Juan Miguel García Gómez1 Abstract Background The microvessels area MVA derived from microvascular proliferation is a biomarker useful for high- grade glioma classification. Nevertheless its measurement is costly labor-intense and invasive. Finding radiologic cor relations with MVA could provide a complementary non-invasive approach without an extra cost and labor intensity and from the first stage. This study aims to correlate imaging markers such as relative cerebral blood volume rCBV and local MVA in IDH-wildtype glioblastoma and to propose this imaging marker as useful for astrocytoma grade 4 classification. Methods Data from 73 tissue blocks belonging to 17 IDH-wildtype glioblastomas and 7 blocks from 2 IDH-mutant astrocytomas were compiled from the Ivy GAP database. MRI processing and rCBV quantification were carried out using ONCOhabitats methodology. Histologic and MRI co-registration was done manually with experts supervision achieving an accuracy of 88.8 of overlay. Spearman s correlation was used to analyze the association between rCBV and microvessel area. Mann-Whitney test was used to study differences of rCBV between blocks with presence or absence of microvessels in IDH-wildtype glioblastoma as well as to find differences with IDH-mutant astrocytoma samples. Results Significant positive correlations were found between rCBV and microvessel area in the IDH-wildtype blocks p Álvarez Torres et al. BMC Cancer 2022 22 40 Page 2 of 13 Keywords Glioblastoma Relative blood volume DSC perfusion Microvascular proliferation IDH mutation Histopathology