GLIOMA-04 BRIDGING THE GAP ON ADULT GLIOMA IMAGING, DIAGNOSIS AND FOLLOW UP IN SUB-SAHARAN AFRICA

Abstract

Abstract Cerebral Gliomas are the most common and devastating primary brain tumors. Prior to 2016 WHO CNS tumor classification update, the grading of gliomas, mainly relied on histological features, including cellularity, nuclear atypia, mitotic activity, vascularity, and necrosis, observed on light microscopy with the aid of immunohistochemistry. A number of studies confirmed that diffuse gliomas demonstrates different growth pattern, clinical behavior, and prognostication based on their genomic alterations, these findings necessitated incorporation of molecular subtypes in glioma classification, and leads to 2016 WHO CNS tumors Classification update. Introduction of molecular criteria into the classification of gliomas has given rise to interesting, wide-ranging implications regarding glioma management. In the current classification, all diffuse gliomas have been grouped based on their growth pattern, clinical behavior, and specifically sharing of the mutational state of the gene that codes for isocitrate dehydrogenase (IDH) in its isoforms (IDH1 and IDH2). Regardless of grade, the first phase in glioma molecular characterization is IDH testing. Mutations in IDH1 and IDH2 are associated with significant increase in progression free survival and overall survival. Immunohistochemistry, Molecular subtyping, Both FISH and genetic sequencing have significant implications in gliomas management and clinical outcome, yet they are not available in our low resource settings. Advanced MRI techniques (DTI, MR Perfussion, MR Spectroscopy, and Functional MRI) have a significant impact in presurgical planning and follow up of glioma patients after surgery and chemo radiation treatment. Radiographic findings can bridge the gap on accurate glioma diagnosis in sub-Saharan Africa through predicting Glioma Molecular subtypes based on clinical presentation and utilizing conventional MRI as a radio genomic tool. Also to emphasis in the utilization of available advanced MRI techniques (DTI, MR Perfussion, and MR spectroscopy) for presurgical planning and follow up of patients after Glioma treatment.