MRS with Cho/Cr, Lac/Cr, CH2/Cr and NAA/Cr ratios, could be more sensitive than MRI and could, in some cases, be predictive of worsening in glioblastomas follow-up. These spectroscopic changes occurred well before clinical deterioration. There is a large variability, but repetition and modelisation of spectroscopic measurements during longitudinal follow-up could allow us to diminish it and to improve glioblastomas prognostic evaluation especially at and after relapses. Studying the relationship between MRS measures, segmentation and perfusion parameters could lead to better understanding of therapeutic response and patients selection, especially with regard to chemotherapy and antiangiogenic molecules and in future stress modulators.
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