Imaging practice in low-grade gliomas among European specialized centers and proposal for a minimum core of imaging

Christian F Freyschlag,Adrià Rofes,Claudius Thomé,Daniele Bagatto,Marie Therese Forster ,Hugues Duffau,Dominik Cordier,Daniel Pinggera,Thomas Santarius,Sandro M Krieg,Silvio Sarubbo,Andrés Felipe Reyes ,Asgeir Store Jakola ,Anja Smits,V Lubrano ,Marco Rossi,Marc Zanello,Fabien Almairac,Rémy Guillevin ,Joanna Sierpowska,Maria Zetterling,Gord Von Campe,John Goodden,Philip C De Witt Hamer,Tomasz Matys,Lydiane Mondot,Johannes Kerschbaumer,Pierre A Robe,Gabriele Miceli,Geert–Jan Rutten ,Marion Rapp,Alexandre Roux,Lorenzo Bello,Johan Pallud,Emmanuel Mandonnet

doi:10.1007/s11060-018-2916-3

Abstract

ObjectiveImaging studies in diffuse low-grade gliomas (DLGG) vary across centers. In order to establish a minimal core of imaging necessary for further investigations and clinical trials in the field of DLGG, we aimed to establish the status quo within specialized European centers.MethodsAn online survey composed of 46 items was sent out to members of the European Low-Grade Glioma Network, the European Association of Neurosurgical Societies, the German Society of Neurosurgery and the Austrian Society of Neurosurgery.ResultsA total of 128 fully completed surveys were received and analyzed. Most centers (n = 96, 75%) were academic and half of the centers (n = 64, 50%) adhered to a dedicated treatment program for DLGG. There were national differences regarding the sequences enclosed in MRI imaging and use of PET, however most included T1 (without and with contrast, 100%), T2 (100%) and TIRM or FLAIR (20, 98%). DWI is performed by 80% of centers and 61% of centers regularly performed PWI.ConclusionA minimal core of imaging composed of T1 (w/wo contrast), T2, TIRM/FLAIR, PWI and DWI could be identified. All morphologic images should be obtained in a slice thickness of ≤ 3 mm. No common standard could be obtained regarding advanced MRI protocols and PET.Importance of the studyWe believe that our study makes a significant contribution to the literature because we were able to determine similarities in numerous aspects of LGG imaging. Using the proposed “minimal core of imaging” in clinical routine will facilitate future cooperative studies.

Highlights

Despite published standards and guidelines on treatment and follow-up of diffuse low-grade glioma (DLGG) patients, daily practice frequently demonstrates the inconsistency of Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Extended author information available on the last page of the article imaging studies among centers [1, 2]
It has been argued that evidence-based practice in the field of DLGG cannot be derived from the standard methodology of oncological randomized clinical trials [3, 4]
The survey was formatted on Survey Grid (EvaSys, Electric Paper Evaluationssysteme GmbH Lüneburg, Germany) and sent to all members of the European Low-Grade Glioma Network (ELGGN), the European Association of Neurosurgical Societies (EANS) plus the German (DGNC) and Austrian Society of Neurosurgery (ÖGNC)

Summary

Introduction

Extended author information available on the last page of the article imaging studies among centers [1, 2]. It has been argued that evidence-based practice in the field of DLGG cannot be derived from the standard methodology of oncological randomized clinical trials [3, 4]. Considering the low prevalence of DLGG [5] and the long survival of patients [6], sufficient data might be better collected by networks of centers working together collaboratively. Oncomolecular features and imaging data (including imaging DLGG growth rates of follow-up MRIs) will be required

Methods

Results

Conclusion