medRxiv PreprintsInternational9 November 2026
Regional Vulnerability to Brain Metastases Reflects Structural, Metabolic and Genetic Organization of the Healthy Brain
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Background: Brain metastases (BMs), the most common intracranial tumor, do not distribute uniformly throughout the brain, but instead preferentially localize to specific regions. Building on known associations with perfusion and the gray-white matter junction, we hypothesized that regional vulnerability to BMs also reflects the cellular and molecular organization of the healthy brain. Methods: In a discovery cohort of 1,406 patients, we generated a voxelwise map of BM distribution and compared it with normative atlases of brain microstructure, vasculature, metabolism, cell-type composition, an
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