Comparison of T2 and FLAIR Imaging for Target Delineation in High Grade Gliomas

Stall, Bronwyn; Zach, Leor; Ning, Holly; Ondos, John; Arora, Barbara; Miller, Robert W.; Smith, Sharon L.; Citrin, Deborah E.; Camphausen, Kevin

doi:10.1016/j.ijrobp.2008.06.062

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…As techniques in radiation oncology have evolved, leading to continuously increasing precision of treatment, more detailed and specific imaging examinations are required. 63,64 Advanced MR imaging techniques postradiation and -chemotherapy have a pivotal role in distinguishing response from pseudoresponse and true disease progression from pseudoprogression. The timing of these scans is critical for accurate assessment, as discussed below.…”

Section: Treatment Planning (Primary Brain Tumors)mentioning

confidence: 99%

MR Imaging of Neoplastic Central Nervous System Lesions: Review and Recommendations for Current Practice

Essig¹,

Anzalone²,

Combs³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY: MR imaging is the preferred technique for the diagnosis, treatment planning, and monitoring of patients with neoplastic CNS lesions. Conventional MR imaging, with gadolinium-based contrast enhancement, is increasingly combined with advanced, functional MR imaging techniques to offer morphologic, metabolic, and physiologic information. This article provides updated recommendations to neuroradiologists, neuro-oncologists, neurosurgeons, and radiation oncologists on the practical applications of MR imaging of neoplastic CNS lesions in adults, with particular focus on gliomas, based on a review of the clinical trial evidence and personal experiences shared at a recent international meeting of experts in neuroradiology, neuro-oncology, neurosurgery, and radio-oncology.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; CBV ϭ cerebral blood volume; CNS ϭ central nervous system; DCE ϭ dynamic contrast-enhanced; DSC ϭ dynamic susceptibility contrast; DTI ϭ diffusion tensor imaging; DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; FSE ϭ fast spin-echo; GFR ϭ glomerular filtration rate; GRE ϭ gradient recalled-echo; K trans ϭ volume transfer coefficient; MRS ϭ MR spectroscopy; PET ϭ positronemission tomography; PWI ϭ perfusion-weighted imaging; rCBV ϭ relative cerebral blood volume; TSE ϭ turbo spin-echo N eoplastic CNS lesions are a heterogeneous group of diseases with a variable outcome that reflects the precision of diagnosis and the delivery of optimal and specific treatment. CNS imaging has a pivotal role in directing management decisions.The goals and requirements for CNS imaging are multiple and include the establishment of a diagnosis and differential diagnosis, with accurate lesion grading for characterization of tumor biology. Imaging is an essential part of the decisionmaking process for therapy and later for planning of surgical or radiotherapeutic interventions. In the case of neurosurgery, neuroimaging can precisely define the location and accurately delineate the lesion and its relationship to eloquent gray-and white-matter structures, before intervention. In radiation therapy, imaging can define and demarcate margins for therapy planning. Imaging is mandatory after therapeutic intervention for monitoring disease and possible side effects.MR imaging is the standard technique for visualizing and characterizing neoplastic CNS lesions, with superior sensitivity compared with alternative modalities.1-4 Diagnosis and treatment planning are routinely based on conventional MR imaging, such as T2-weighted imaging, FLAIR, and T1 unenhanced FSE or GRE. Following contrast-enhanced T1-weighted imaging, sequences including 3D GRE or 2D TSE or FSE are used routinely for assessment of brain tumors. Through enhancing tissue relaxation, gadolinium-based contrast media improve the sensitivity and specificity of conventional and perfusion-weighted MR imaging examinations, with the capability to identify lesions not visible on unenhanced MR imaging and to provide additional information o...

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Section: Treatment Planning (Primary Brain Tumors)mentioning

confidence: 99%

MR Imaging of Neoplastic Central Nervous System Lesions: Review and Recommendations for Current Practice

Essig¹,

Anzalone²,

Combs³

et al. 2011

AJNR Am J Neuroradiol

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“…The utility of FLAIR MRI is that, as an inversion recovery MRI technique, it can essentially nullify or subtract the effects of fluid, thereby suppressing CSF in brain imaging. This can be especially useful in planning radiation therapy (to be discussed in more detail below) when it is of vital importance to delineate malignancy from native vital brain parenchyma [31]. The gold standard for diagnosis, of course, remains procurement of tissue for histological confirmation that can either be accomplished either diagnostically through stereotactic biopsy or, more commonly, diagnostically and therapeutically with tissue samples obtained during craniotomy for the purposes of tumor resection or debulking.…”

Section: Diagnosismentioning

confidence: 99%

High Grade Glioma — Standard Approach, Obstacles and Future Directions

Joshi¹,

Zuniga²

2014

Tumors of the Central Nervous System - Primary and Secondary

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“…5,6 But, it does not provide reliable information on many parameters of tumor physiology like microvascularity, angiogenesis, metabolism, micronecrosis, or cellularity, which can be obtained by inclusion of advanced MRI techniques like fluid attenuated inversion recovery (FLAIR), diffusionweighted MRI (DWI), perfusion scans and magnetic resonance spectroscopy. [7][8][9] Pre-operative accurate prediction of the histological nature of gliomas and their histological grading remains a challenge. It is also critical for making optimum plan of management and for prognosticating the disease beforehand, so that most cost-effective therapeutic choice with the best patient outcome can be determined.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of magnetic resonance imaging diagnosis and grading of gliomas

Shukla¹,

Chandankhede

Sahoo

2022

Int Surg J

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Background: Low- and high-grade gliomas differ in clinical presentation, natural history, treatment outcome, prognosis, survival pattern, histopathological, immunohistochemical and biomolecular profiles. Accurate pre-operative prediction of histopathological grade of gliomas remains challenging, and is critical for making optimum management plan and prognosticating the disease beforehand to determine the most cost-effective therapeutic choice with the best patient outcome. This prospective observational study on 54 patients aims to determine accuracy of pre-operative magnetic resonance imaging (MRI) in diagnosing and grading gliomas.Methods: Pre-operative grading of MRI-suspected gliomas was done by assigning scores of 0-2 to 9 criteria – midline crossing, perilesional edema, signal heterogeneity, intra-tumoral hemorrhage, tumor border definition, cystic/necrotic changes, mass effect, contrast enhancement and diffusion restriction. Total scores of 0-5, 6-9 and 10-18 were considered radiologically low, intermediate and high grades respectively and correlation with World Health Organization (WHO) grades I+II, III and IV respectively was determined.Results: MRI diagnosed 85.18% gliomas correctly. Pre-operative MR grading was 76-89% sensitive and 86-96% specific in predicting the histopathological grade of the gliomas. Signal heterogeneity and contrast enhancement had the highest whereas midline crossing and mass effect had the lowest correlation with histopathological grade.Conclusions: Pre-operative MRI is highly specific and somewhat less sensitive tool for grading gliomas pre-operatively. The diagnostic yield is higher for LGGs and GBMs, compared to anaplastic gliomas, probably due to their mixed or intermediate features.

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Comparison of T2 and FLAIR Imaging for Target Delineation in High Grade Gliomas

Cited by 3 publications

References 25 publications

MR Imaging of Neoplastic Central Nervous System Lesions: Review and Recommendations for Current Practice

MR Imaging of Neoplastic Central Nervous System Lesions: Review and Recommendations for Current Practice

High Grade Glioma — Standard Approach, Obstacles and Future Directions

Accuracy of magnetic resonance imaging diagnosis and grading of gliomas

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