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

Otto Rapalino, Pia C Sundgren, Soonmee Cha, Linda Knutsson, Marion Smits, Leland S Hu, Timothy J Kaufmann, Norbert Galldiks

Journal: AJR. American journal of roentgenology 2025;224(1):e2330612

PMID: 38477525

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Abstract

This Expert Panel Narrative Review explores the current status of advanced MRI and PET techniques for the posttherapeutic 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 posttreatment effects include DWI and diffusion-tensor imaging; perfusion MRI techniques including dynamic susceptibility contrast (DSC), dynamic contrast-enhanced, and arterial spin labeling MRI; MR spectroscopy (MRS) including assessment of 2-hydroxyglutarate (2HG) concentration; glucose- and amino acid (AA)-based PET; and amide proton transfer imaging. Updated criteria for the Response Assessment in Neuro-Oncology are presented. Given the abundant supporting clinical evidence, the panel supports a recommendation that routine response assessment after high-grade glioma 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 review 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.

Address: Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054.; Department of Cancer Biology, Mayo Clinic, Phoenix, AZ.; Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ.; Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.; Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.; Medical Delta, Delft, The Netherlands.; Department of Radiology, Mayo Clinic, Rochester, MN.; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD.; Department of Neurology, Johns Hopkins University, Baltimore, MD.; Department of Medical Radiation Physics, Lund University, Lund, Sweden.; Department of Radiology, Massachusetts General Hospital, Boston, MA.; Department of Radiology, Harvard Medical School, Boston, MA.; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany.; Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany.; Institution of Clinical Sciences Lund/Radiology, Lund University, Lund, Sweden.; Lund Bioimaging Center, Lund University, Lund, Sweden.; Department of Medical Imaging and Function, Skane University Hospital, Lund, Sweden.; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA.; Department of Neurological Surgery, University of California, San Francisco, CA.

DOI: 10.2214/AJR.23.30612

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MeSH Terms: Humans, Glioma, Brain Neoplasms, Magnetic Resonance Imaging, Positron-Emission Tomography, Neoplasm Grading, Contrast Media