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Bhattacharya K, Rastogi S, Mahajan A. Post-treatment imaging of gliomas: challenging the existing dogmas. Clin Radiol 2024; 79:e376-e392. [PMID: 38123395 DOI: 10.1016/j.crad.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Gliomas are the commonest malignant central nervous system tumours in adults and imaging is the cornerstone of diagnosis, treatment, and post-treatment follow-up of these patients. With the ever-evolving treatment strategies post-treatment imaging and interpretation in glioma remains challenging, more so with the advent of anti-angiogenic drugs and immunotherapy, which can significantly alter the appearance in this setting, thus making interpretation of routine imaging findings such as contrast enhancement, oedema, and mass effect difficult to interpret. This review details the various methods of management of glioma including the upcoming novel therapies and their impact on imaging findings, with a comprehensive description of the imaging findings in conventional and advanced imaging techniques. A systematic appraisal for the existing and emerging techniques of imaging in these settings and their clinical application including various response assessment guidelines and artificial intelligence based response assessment will also be discussed.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rastogi
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- Department of imaging, The Clatterbridge Cancer Centre, NHS Foundation Trust, Pembroke Place, Liverpool L7 8YA, UK; University of Liverpool, Liverpool L69 3BX, UK.
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Borja AJ, Saini J, Raynor WY, Ayubcha C, Werner TJ, Alavi A, Revheim ME, Nagaraj C. Role of Molecular Imaging with PET/MR Imaging in the Diagnosis and Management of Brain Tumors. PET Clin 2022; 17:431-451. [PMID: 35662494 DOI: 10.1016/j.cpet.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gliomas are the most common primary brain tumors. Hybrid PET/MR imaging has revolutionized brain tumor imaging, allowing for noninvasive, simultaneous assessment of morphologic, functional, metabolic, and molecular parameters within the brain. Molecular information obtained from PET imaging may aid in the detection, classification, prognostication, and therapeutic decision making for gliomas. 18F-fluorodeoxyglucose (FDG) has been widely used in the setting of brain tumor imaging, and multiple techniques may be employed to optimize this methodology. More recently, a number of non-18F-FDG-PET radiotracers have been applied toward brain tumor imaging and are used in clinical practice.
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Affiliation(s)
- Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jitender Saini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, Karnataka 560-029, India
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Cyrus Ayubcha
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway
| | - Chandana Nagaraj
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, Karnataka 560-029, India.
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Peer S, Mangalore S, Saini J, Nagaraj C. Incremental Utility of Tc-99m Glucohepatonate Single-Photon Emission Computed Tomography over 18F-Flourodeoxyglucose Positron Emission Tomography in Diagnosis of Brain Tumor Recurrence - Old is Gold. Indian J Nucl Med 2021; 36:53-55. [PMID: 34040298 PMCID: PMC8130701 DOI: 10.4103/ijnm.ijnm_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 11/23/2022] Open
Abstract
Detection of recurrence of a brain tumor after treatment is one of the most important and challenging diagnostic problems in neuro-oncological practice. In spite of technical advances in imaging modalities, sometimes, certain clinical presentations and manifestations can lead to a diagnostic dilemma even with the best of the technical know-how. We present a case of recurrence of anaplastic oligoastrocytoma (World Health Organization Grade III), where the patient's initial clinical presentation and the F-18 flourodeoxyglucose positron emission tomography (PET) magnetic resonance imaging findings were suggestive of stroke-like migraine attacks after radiation therapy syndrome. Due to a seizure episode before PET image acquisition, intense gyral uptake was noted in the left parietal lobe which made it difficult to ascertain the presence of a tumor recurrence. However, Tc-99m glucohepatonate single-photon emission computed tomography done after 1 week revealed radiotracer uptake within the site corresponding to the primary tumor, and a diagnosis of recurrence was made.
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Affiliation(s)
- Sameer Peer
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sandhya Mangalore
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Jitendra Saini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Chandana Nagaraj
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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