Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

S C Thust,T Yousry,A D Waldman,N Bargallo,M Bendszus,V K Katsaros,A Ramos,M W Vernooij,M Smits,S Heiland,H R Jäger,A Falini,C Godi,P C Sundgren

doi:10.1007/s00330-018-5314-5

Abstract

ObjectivesAt a European Society of Neuroradiology (ESNR) Annual Meeting 2015 workshop, commonalities in practice, current controversies and technical hurdles in glioma MRI were discussed. We aimed to formulate guidance on MRI of glioma and determine its feasibility, by seeking information on glioma imaging practices from the European Neuroradiology community.MethodsInvitations to a structured survey were emailed to ESNR members (n=1,662) and associates (n=6,400), European national radiologists’ societies and distributed via social media.ResultsResponses were received from 220 institutions (59% academic). Conventional imaging protocols generally include T2w, T2-FLAIR, DWI, and pre- and post-contrast T1w. Perfusion MRI is used widely (85.5%), while spectroscopy seems reserved for specific indications. Reasons for omitting advanced imaging modalities include lack of facility/software, time constraints and no requests. Early postoperative MRI is routinely carried out by 74% within 24–72 h, but only 17% report a percent measure of resection. For follow-up, most sites (60%) issue qualitative reports, while 27% report an assessment according to the RANO criteria. A minority of sites use a reporting template (23%).ConclusionClinical best practice recommendations for glioma imaging assessment are proposed and the current role of advanced MRI modalities in routine use is addressed.Key Points• We recommend the EORTC-NBTS protocol as the clinical standard glioma protocol.• Perfusion MRI is recommended for diagnosis and follow-up of glioma.• Use of advanced imaging could be promoted with increased education activities.• Most response assessment is currently performed qualitatively.• Reporting templates are not widely used, and could facilitate standardisation.

Highlights

Gliomas are a diverse group of neoplasms, the principal treatment for which is surgical resection followed by radiation and/or chemotherapy
Perfusion Magnetic resonance imaging (MRI) is recommended for diagnosis and follow-up of glioma
This paper aims to provide best clinical practice recommendations on conventional and advanced MRI of glioma patients and assesses whether the EORTC-National Brain Tumor Society (NBTS) protocol would be suitable for routine clinical practice

Summary

Introduction

Gliomas are a diverse group of neoplasms, the principal treatment for which is surgical resection followed by radiation and/or chemotherapy. Despite ongoing efforts to advance treatments, practically all adult gliomas eventually progress and have an overall poor prognosis [1]. Magnetic resonance imaging (MRI) is fundamental to the characterisation of brain tumours, guides the surgical strategy and is required to monitor treatment response. Differences in scanning protocols (spatial and contrast resolution, image planes, sequences, etc.), whether within the same institution or between institutions, may affect image interpretation, assessment of contrast enhancement and (volume) changes in follow-up examinations [3]. The absence of uniform protocols may delay their implementation, hamper the establishment of threshold values, and in the worst case render the technique non-diagnostic

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