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MRI in treatment of adult gliomas
John W Henson1, Paola Gaviani, R Gilberto Gonzalez
1Division of Neuroradiology and Steven E and Catherine Pappas, Center for Neuro-oncology, Massachusetts General Hospital, Boston, MA 02114, USA. henson@helix.mgh.harvard.edu <henson@helix.mgh.harvard.edu>
Abstract:
Diffuse astrocytomas of the adult cerebral hemispheres are unique among tumours in human beings in the extent to which their imaging features are related to histopathological characteristics and clinical behaviour. However, understanding is still restricted about the value of imaging features in the measurement of response and of progression in these tumours. The present approach used in clinical trials, which consists of an anatomical measurement of the enhancing tumour on MRI, has many problems, and might not be acceptable as a surrogate endpoint for survival in patients with glioblastoma who are enrolled in clinical trials. Dynamic imaging techniques, such as capillary permeability mapping, are being used in studies of new drugs that target specific molecular features of gliomas; however, the validity of these techniques has not been elucidated. Diffusion imaging can be valuable for fibre-tract mapping to assist surgical planning and might become useful in measuring early response to treatment in densely cellular tumours. Functional imaging techniques can be used to localise motor, sensory, and language-control areas before surgery. Intraoperative MRI has produced improvements in the extent of tumour resection, and molecular imaging is another technique on the horizon, which could come to have a role in clinical trials in the near future. Thus, as a rapidly expanding sphere of investigation, brain-tumour imaging is producing great excitement. The aim of these new techniques is to aid the identification of more effective treatments.
Insights
Advanced brain tumor imaging techniques show promise for better treatment response assessment and surgical planning in diffuse astrocytomas. These methods aim to improve the identification of more effective therapies for brain tumors.
Area of Science:
- Neuro-oncology
- Radiology
- Medical Imaging
Background:
- Diffuse astrocytomas exhibit unique imaging features correlating with histopathology and clinical behavior.
- Current methods for assessing tumor response and progression in clinical trials, like anatomical MRI measurements, have limitations.
- The validity of dynamic imaging techniques for evaluating new glioma-targeting drugs requires further elucidation.
Purpose of the Study:
- To explore the value of advanced imaging features in measuring response and progression of diffuse astrocytomas.
- To discuss the limitations of current anatomical MRI-based assessments in clinical trials.
- To highlight emerging imaging techniques for improved brain tumor management.
Main Methods:
- Review of current and emerging brain tumor imaging techniques, including MRI, dynamic imaging (capillary permeability mapping), diffusion imaging, functional imaging, intraoperative MRI, and molecular imaging.
- Discussion of the application of these techniques in surgical planning, treatment response measurement, and clinical trials.
Main Results:
- Anatomical measurement of enhancing tumor on MRI presents challenges as a surrogate endpoint for glioblastoma survival.
- Diffusion imaging shows potential for fiber-tract mapping and early treatment response assessment in cellular tumors.
- Functional imaging aids in localizing critical brain areas for surgical planning.
- Intraoperative MRI has improved tumor resection extent.
Conclusions:
- Brain tumor imaging is a rapidly evolving field with significant potential for identifying more effective treatments.
- Emerging techniques like molecular imaging may play a future role in clinical trials.
- Advanced imaging modalities offer improved insights into tumor characteristics and treatment efficacy.
