Abstract
Management of gliomas following initial diagnosis requires thoughtful presurgical planning followed by regular imaging to monitor treatment response and survey for new tumor growth. Traditional MR imaging modalities such as T1 post-contrast and T2-weighted sequences have long been a staple of tumor diagnosis, surgical planning, and post-treatment surveillance. While these sequences remain integral in the management of gliomas, advances in imaging techniques have allowed for a more detailed characterization of tumor characteristics. Advanced MR sequences such as perfusion, diffusion, and susceptibility weighted imaging, as well as PET scans have emerged as valuable tools to inform clinical decision making and provide a non-invasive way to help distinguish between tumor recurrence and pseudoprogression. Furthermore, these advances in imaging have extended to the operating room and assist in making surgical resections safer. Nevertheless, surgery, chemotherapy, and radiation treatment continue to make the interpretation of MR changes difficult for glioma patients. As analytics and machine learning techniques improve, radiomics offers the potential to be more quantitative and personalized in the interpretation of imaging data for gliomas. In this review, we describe the role of these newer imaging modalities during the different stages of management for patients with gliomas, focusing on the pre-operative, post-operative, and surveillance periods. Finally, we discuss radiomics as a means of promoting personalized patient care in the future.
Highlights
Gliomas are the most common primary brain tumor with varying prognosis depending on their grade and genomic profile (Louis et al, 2021)
After the initial diagnosis of lesion concerning for an intra-axial brain tumor is made, most institutions employ a standardized protocol for lesion characterization and pre-operative planning. 3-dimensional (3D) T1 pre- and post-contrast-enhanced, T2 contrast-enhanced, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) at a magnetic field strength of a minimum of 1.5 tesla (T) are commonly a part of these protocols (Ellingson et al, 2015)
There are studies to suggest that combination of functional modalities such as Functional MRI (fMRI) or Diffusion tensor imaging (DTI) with navigated repetitive TMS (nrTMS) may lead to improved functional mapping and clinical outcomes, but further investigation is needed to make these practices commonplace in the clinical setting (Ille et al, 2015; Könönen et al, 2015; Sollmann et al, 2018)
Summary
Traditional MR imaging modalities such as T1 post-contrast and T2-weighted sequences have long been a staple of tumor diagnosis, surgical planning, and post-treatment surveillance While these sequences remain integral in the management of gliomas, advances in imaging techniques have allowed for a more detailed characterization of tumor characteristics. Advanced MR sequences such as perfusion, diffusion, and susceptibility weighted imaging, as well as PET scans have emerged as valuable tools to inform clinical decision making and provide a noninvasive way to help distinguish between tumor recurrence and pseudoprogression. These advances in imaging have extended to the operating room and assist in making surgical resections safer.
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