Advanced Imaging in the Diagnosis and Response Assessment of High-Grade Glioma:Expert Panel Narrative Review.

in AJR. American journal of roentgenology by Leland S Hu, Marion Smits, Timothy J Kaufmann, Linda Knutsson, Otto Rapalino, Norbert Galldiks, Pia C Sundgrene, Soonmee Cha

TLDR

  • The study is about using advanced MRI and PET techniques to figure out if a person's brain tumor has come back after treatment. The study looked at different ways to do this, like using DWI and diffusion tensor imaging, perfusion MRI techniques, MR spectroscopy, and PET. The study found that perfusion MRI was the best way to tell if the tumor had come back. The study also found that some techniques, like 2HG MRS and AA PET, need to be more widely available or have more insurance funding in the US before they can be used more often. The study also suggests some ways to do more research and find new ways to help people with brain tumors.

Abstract

ThisExpert Panel Narrative explores the current status of advanced MRI and PET techniques for the post-therapeutic response assessment of high-grade adult-type gliomas, focusing on ongoing clinical controversies in current practice. Discussed techniques that complement conventional MRI and aid the differentiation of recurrent tumor from post-treatment effects include DWI and diffusion tensor imaging; perfusion MRI techniques including dynamic susceptibility contrast (DSC), dynamic contrast-enhanced MRI, and arterial spin labeling; MR spectroscopy including assessment of 2-hydroxyglutarate (2HG) concentration; glucose- and amino acid (AA)-based PET; and amide proton transfer imaging. Updated criteria for Response Assessment in Neuro-Oncology are presented. Given the abundant supporting clinical evidence, the panel supports a recommendation that routine response assessment after HGG treatment should include perfusion MRI, particularly given the development of a consensus recommended DSC-MRI protocol. Although published studies support 2HG MRS and AA PET, these techniques' widespread adoption will likely require increased availability (for 2HG MRS) or increased insurance funding in the United States (for AA PET). The article concludes with a series of consensus opinions from the author panel, centered on the clinical integration of the advanced imaging techniques into posttreatment surveillance protocols.

Overview

  • The study focuses on the use of advanced MRI and PET techniques for post-therapeutic response assessment of high-grade adult-type gliomas. The hypothesis being tested is the effectiveness of these techniques in differentiating recurrent tumor from post-treatment effects. The methodology used includes a review of published studies and expert opinions from a panel of experts. The primary objective of the study is to provide updated criteria for Response Assessment in Neuro-Oncology and to recommend the use of perfusion MRI for routine response assessment after HGG treatment. The study aims to answer the question of which advanced imaging techniques are most effective for post-treatment surveillance of high-grade adult-type gliomas.

Comparative Analysis & Findings

  • The study compares the outcomes observed under different experimental conditions or interventions, including DWI and diffusion tensor imaging, perfusion MRI techniques including dynamic susceptibility contrast (DSC), dynamic contrast-enhanced MRI, and arterial spin labeling, MR spectroscopy including assessment of 2-hydroxyglutarate (2HG) concentration, glucose- and amino acid (AA)-based PET, and amide proton transfer imaging. The study identifies significant differences or similarities in the results between these conditions, with perfusion MRI being the most effective technique for differentiating recurrent tumor from post-treatment effects. The key findings of the study support the recommendation that routine response assessment after HGG treatment should include perfusion MRI, particularly given the development of a consensus recommended DSC-MRI protocol. The study also highlights the need for increased availability of 2HG MRS and increased insurance funding in the United States for AA PET in order for these techniques to be widely adopted.

Implications and Future Directions

  • The study's findings have significant implications for the field of research and clinical practice, as they provide updated criteria for Response Assessment in Neuro-Oncology and recommend the use of perfusion MRI for routine response assessment after HGG treatment. The study identifies limitations in the widespread adoption of 2HG MRS and AA PET, which will likely require increased availability and insurance funding in order for these techniques to be widely adopted. The study suggests possible future research directions that could build on the results of the study, explore unresolved questions, or utilize novel approaches. These include the development of more advanced perfusion MRI techniques, the integration of other imaging modalities such as CT and PET, and the development of personalized treatment plans based on individual patient characteristics.
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