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The 2016 revised World Health Organization classification and grading system of gliomas includes additional information obtained from molecular biomarkers.
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Modified Response Assessment in Neuro-oncology (RANO) criteria divide treatment response in gliomas into complete response, partial response, progressive disease, and stable disease based on assessment of measurable and nonmeasurable lesions.
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Pseudoprogression is identified radiographically when tumors undergo growth similar to true disease
Imaging Surveillance of Gliomas: Role of Basic and Advanced Imaging Techniques
Section snippets
Key points
Treatment and response assessment of high-grade gliomas
The International Society of Neuropathology established the Haarlem guidelines to consider how the molecular profile of a tumor can be incorporated into the current grading of tumors.4 An understanding of this schematic diagnosis is essential because it reflects on the anticipated treatment protocols and hence the prognosis of the tumors.5
Preoperative functional imaging including tractography, precision surgical navigation techniques aided by magnetic resonance (MR) imaging studies,
Treatment response assessment and surveillance of low-grade gliomas
Diffuse low-grade gliomas (LGGs) are slow-growing indolent lesions, but approximately 70% have the potential for anaplastic transformation within 5 to 10 years of diagnosis.53 In accordance with the revised 2016 WHO classification, the term low-grade glioma commonly includes grade II gliomas. These tumors often show little to no enhancement and are hyperintense with well-defined margins. However, these tumors require continued surveillance because they have infiltrative margins and can progress
Summary
It is important to keep updated with the latest recommendations for serial assessment of both high-grade gliomas and LGGs. Although conventional imaging-based metrics continue to be heavily used for surveillance of gliomas, there is an increasing role of advanced imaging modalities such as perfusion imaging in helping detect early recurrences and in prognostication.
Clinics care points
The diagnosis of recurrence or progression of high grade gliomas is an essential aspect of management of these tumors. Treatment strategies are dependent on the accurate diagnosis of progressive disease and pseudoprogression. Advanced imaging techniques may be helpful in differentiating true progression and pseudoprogression. Advances in treatment have resulted in distinct changes in imaging morphologies of the tumors especially on MR studies which are the mainstay in the diagnosis and follow up
Disclosure
The authors have nothing to disclose.
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