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Molecular Imaging of Diffuse Low Grade Glioma

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Diffuse Low-Grade Gliomas in Adults

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Abstract

Beyond defining tumor extent and anatomic location, recent advances in MRI and PET allow for the non-invasive physiologic, metabolic and molecular imaging of diffuse low-grade glioma. How this information can be best combined with detailed molecular characterization of tumors, in order to produce applicable markers of prognosis and response to therapy, remains to be determined. The impact on imaging of molecular features of gliomas including 1p/19q loss of heterozygosity (LOH) and the IDH1 and IDH2 mutations is discussed. Newer MR sequences and data mining techniques including diffusion and perfusion MRI and textural analysis may better stratify tumor prognosis and grade. Additionally, measurement of the oncometabolite 2-HG with MR spectroscopy appears clinically feasible, although the relationship to outcomes is yet to be determined. Lastly PET with amino acid tracers including C11-MET, FET and FDOPA provide additional avenues of tumor characterization that are unfettered by the high background uptake of FDG. The future may be characterized by gains in predictive, rather than merely prognostic markers, that could help optimize patient outcomes. As more targeted therapies become available, it will also be critical to develop early response indicators that are acquired prior to change in tumor size. To date, many imaging biomarkers lack the rigorous validation necessary for clinical decision-making, but ongoing efforts could yield such data in the near future. As more is understood about the relationship between imaging and underlying molecular features of disease, we can continue to refine treatment strategies in a manner more precisely tailored to individual patients.

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Acknowledgements

The authors would like to thank Benjamin Ellingson, PhD, for providing some of the figures.

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  1. Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA, 90095, USA

    Whitney B. Pope MD, PhD & Kevin Spitler MD

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  1. Whitney B. Pope MD, PhD
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Correspondence to Whitney B. Pope MD, PhD .

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  1. Department of Neurosurgery, Montpellier University Medical Center, INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France

    Hugues Duffau

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Pope, W.B., Spitler, K. (2017). Molecular Imaging of Diffuse Low Grade Glioma. In: Duffau, H. (eds) Diffuse Low-Grade Gliomas in Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-55466-2_10

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