Update on neuroimaging in brain tumours

To highlight some of the recent advances in magnetic resonance imaging (MRI), in terms of acquisition, analysis, and interpretation for primary diagnosis, treatment planning, and surveillance of patients with a brain tumour.

The rapidly emerging field of radiomics associates large numbers of imaging features with clinical characteristics. In the context of glioma, attempts are made to correlate such imaging features with the tumour genotype, using so-called radiogenomics. The T2-fluid attenuated inversion recovery (FLAIR) mismatch sign is an easy to apply imaging feature for identifying isocitrate dehydrogenase-mutant 1p/19q intact glioma with very high specificity.For treatment planning, resting state functional MRI (fMRI) may become as powerful as task-based fMRI. Functional ultrasound has shown the potential to identify functionally active cortex during surgery.For tumour response assessment automated techniques have been developed. Multiple new guidelines have become available, including those for adult and paediatric glioma and for leptomeningeal metastases, as well as on brain metastasis and perfusion imaging.

Neuroimaging plays a central role but still often falls short on essential questions. Advanced imaging acquisition and analysis techniques hold great promise for answering such questions, and are expected to change the role of neuroimaging for patient management substantially in the near future.