Advances in magnetic resonance imaging of brain tumours

Magnetic resonance imaging (MRI) of brain tumours provides excellent anatomical detail of brain tumours and can also reveal the biology, cellular structure and vascular dynamics of a tumour, although the use of such features in routine clinical practice has yet to be realized. In this review the latest advances in MRI of brain tumours are discussed and their clinical applications highlighted.

A large international study is underway to develop more powerful methods for automated classification of MR spectra based on the acquisition of large datasets of tumour spectra. Diffusion weighted imaging can help in the distinction between gliomas and abscesses, and perfusion weighted imaging can predict response to radiotherapy in low grade gliomas as well as distinguishing between different types of cerebral metastases. Intraoperative MRI has now been shown to be technically feasible, safe and effective in obtaining histological information as well as increasing the likelihood of complete resection for pituitary tumours and gliomas. Functional MRI and magnetic source imaging are alternative modalities that help the surgeon to avoid eloquent brain areas but may occasionally provide misleading information. Diffusion tensor imaging can demonstrate the effect of a tumour on white matter tracts and provides complementary information to that from other techniques that reveal areas of eloquent cortex.

Advances in MRI techniques are providing better diagnostic and therapeutic information, but can only ever be a surrogate marker of physiological and pathological processes; until it can routinely be used to image the brain at a cellular level, MRI will always be secondary to pathology in the final diagnostic evaluation.