AUTHOR=Gaudino Simona , Marziali Giammaria , Giordano Carolina , Gigli Riccardo , Varcasia Giuseppe , Magnani Francesca , Chiesa Silvia , Balducci Mario , Costantini Alessandro Maria , Della Pepa Giuseppe Maria , Olivi Alessandro , Russo Rosellina , Colosimo Cesare 

TITLE=Regorafenib in Glioblastoma Recurrence: How to Deal With MR Imaging Treatments Changes

JOURNAL=Frontiers in Radiology

VOLUME=Volume 1 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/radiology/articles/10.3389/fradi.2021.790456

DOI=10.3389/fradi.2021.790456

ISSN=2673-8740

ABSTRACT=Treatment of recurrent high grade gliomas remains a major challenge of daily neuro-oncology practice and imaging findings of new therapies may be challenging. Regorafenib is a multi-kinase inhibitor that has recently been introduced into clinical practice to threat recurrent glioblastoma, bringing with it a novel panel of MRI imaging findings. Based on the few data in the literature and on our personal experience, we have identified the main MRI changes during Regorafenib therapy, and then we defined two different patterns, trying to create a simple summary line of the main changes of pathological tissue during therapy. We named these patterns respectively PATTERN A (less frequent, similar to classical progression disease) and PATTERN B (more frequent, with decrease diffusivity and decrease contrast-enhancement). We have also reported MR changes concerning signal intensity on T1-weigted and T2-weigthed images, SWI, and perfusion imaging, derived from the literature (small series or case reports), and from our clinical experience. The clinical implication of these imaging modifications remains to be defined, taking into account that we are still at the dawn in evaluation of such imaging modifications.