Glioma response assessment: Classic pitfalls, novel confounders, and emerging imaging tools

Abstract

Neuroimaging plays a pivotal role in the care of patients with infiltrating gliomas, in whom imaging changes are often the first indications of tumor response or progression. Unfortunately, evaluation of glioma response is often not straightforward, even for experienced radiologists. Post-surgical or radiation-related changes may mimic the appearance of disease progression, while medications such as corticosteroids and antiangiogenic agents may mimic tumor response without truly arresting tumor growth or improving patient survival. Immunotherapy response can result in inflammatory changes which manifest as progressively increasing tumor enhancement and edema over months. Many of these pitfalls can be minimized or avoided altogether by the use of modern brain tumor response criteria, while others will require new imaging tools before they can be fully addressed. Advanced MRI methods and novel positron emission tomography (PET) agents are proving important for this purpose, and their role will undoubtedly continue to grow in the future.

Applying artificial intelligence for cancer immunotherapy

“… 106 developed a semisupervised DL method, extracting effective CT-based data, to predict the risk of recurrence of high-grade serous ovarian cancer. Additionally, the application of AI in immunotherapy is becoming increasingly extensive, such as searching for biomarkers for diagnosis and prognosis and describing the phenotypic information of tumor cells 107 . Effland et al.…”

Assessment of Sodium MRI at 7 Tesla as Predictor of Therapy Response and Survival in Glioblastoma Patients

“…In this context, the early identification of tumor relapse remains a major challenge. Current assessment of response to therapy is based on the updated response assessment in neuro-oncology working group (RANO) criteria, which classify clinical follow-up MRI ( Wen et al, 2010 ; Johnson et al, 2019 ). This approach suffers essential limitations due to the incidence of pseudo-progressions (PsPD) especially shortly after treatment ( de Wit et al, 2004 ; Wen et al, 2010 ).…”

“…This approach suffers essential limitations due to the incidence of pseudo-progressions (PsPD) especially shortly after treatment ( de Wit et al, 2004 ; Wen et al, 2010 ). Repeated imaging studies are necessary to rule out PsPD ( Wen et al, 2010 ; Johnson et al, 2019 ), which impedes early identification of tumor relapse and delays potential 2nd-line therapies as part of personalized treatment approaches. Consequently, imaging techniques that enable an early or even real-time response assessment to guide therapy protocols are highly desirable.…”

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“…Much has been revealed about the mechanism of occurrence and progression of brain glioma and considerable progress has been achieved in the diagnosis and treatment of brain glioma (Cheng et al, 2017). However, the mortality and postoperative survival of brain glioma (Johnson et al, 2019) patients are not significantly improved (Reardon and Wen, 2015). Rho proteins, with a relative molecular mass of 20-25kD, are GTP-binding proteins.…”