Imaging Surveillance of Gliomas: Role of Basic and Advanced Imaging Techniques

https://doi.org/10.1016/j.rcl.2021.01.006Get rights and content

Section snippets

Key points

  • The 2016 revised World Health Organization classification and grading system of gliomas includes additional information obtained from molecular biomarkers.

  • 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.

  • Pseudoprogression is identified radiographically when tumors undergo growth similar to true disease

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.

First page preview

First page preview
Click to open first page preview

References (56)

  • T.A. Auer et al.

    Evaluation of the apparent diffusion coefficient in patients with recurrent glioblastoma under treatment with bevacizumab with radiographic pseudoresponse

    J Neuroradiol

    (2019)
  • M.J. van den Bent et al.

    Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas

    Lancet Oncol

    (2011)
  • Q.T. Ostrom et al.

    CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012-2016

    Neuro Oncol

    (2019)
  • D.N. Louis et al.

    The 2016 World Health Organization Classification of tumors of the central nervous system: a summary

    Acta Neuropathol

    (2016)
  • M. Back et al.

    Influence of molecular classification in anaplastic glioma for determining outcome and future approach to management

    J Med Imaging Radiat Oncol

    (2019)
  • A. Bates et al.

    Primary and metastatic brain tumours in adults: summary of NICE guidance

    BMJ

    (2018)
  • M.A. Vogelbaum et al.

    Application of novel response/progression measures for surgically delivered therapies for gliomas: Response Assessment in Neuro-Oncology (RANO) working group

    Neurosurgery

    (2012)
  • K.S. Tralins et al.

    Volumetric analysis of 18F-FDG PET in glioblastoma multiforme: prognostic information and possible role in definition of target volumes in radiation dose escalation

    J Nucl Med

    (2002)
  • N.L. Albert et al.

    Response assessment in neuro-oncology working group and European Association for neuro-oncology recommendations for the clinical use of PET imaging in gliomas

    Neuro Oncol

    (2016)
  • R. Stupp et al.

    Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma

    N Engl J Med

    (2005)
  • W. Wick et al.

    Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide

    Neuro Oncol

    (2016)
  • M. Westphal et al.

    A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma

    Neuro Oncol

    (2003)
  • L.C. Hygino da Cruz et al.

    Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma

    AJNR Am J Neuroradiol

    (2011)
  • J.S. Young et al.

    Immunotherapy for high grade gliomas: a clinical update and practical considerations for neurosurgeons

    World Neurosurg

    (2019)
  • U.N. Chukwueke et al.

    Use of the Response Assessment in Neuro-Oncology (RANO) criteria in clinical trials and clinical practice

    CNS Oncol

    (2019)
  • D.R. Macdonald et al.

    Response criteria for phase II studies of supratentorial malignant glioma

    J Clin Oncol

    (1990)
  • O.L. Chinot et al.

    Response assessment criteria for glioblastoma: practical adaptation and implementation in clinical trials of antiangiogenic therapy

    Curr Neurol Neurosci Rep

    (2013)
  • P.Y. Wen et al.

    Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group

    J Clin Oncol

    (2010)
  • Cited by (1)

    • Current status in brain glioblastoma imaging (MRI, CT-Scan)

      2023, New Insights into Glioblastoma: Diagnosis, Therapeutics and Theranostics
    View full text