However, due to the complex interplay between tumor cells and their microenvironment, modeling and quantifying the direction of this co-optive growth pattern in imaging studies remains challenging.7,11–13 An important biomarker in determining prognosis and reaction to treatment is the O6-methylguanine-DNA methyltransferase (MGMT) gene, where hypermethylation of said gene indicates a more favorable outcome.14 Previous literature suggests methylation status of the MGMT gene has no influence on the GBM growth pattern.15 The gene discussed is MGMT; the disease is neoplasm.