AUTHOR=Malik Dania G. , Rath Tanya J. , Urcuyo Acevedo Javier C. , Canoll Peter D. , Swanson Kristin R. , Boxerman Jerrold L. , Quarles C. Chad , Schmainda Kathleen M. , Burns Terry C. , Hu Leland S. 

TITLE=Advanced MRI Protocols to Discriminate Glioma From Treatment Effects: State of the Art and Future Directions

JOURNAL=Frontiers in Radiology

VOLUME=Volume 2 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/radiology/articles/10.3389/fradi.2022.809373

DOI=10.3389/fradi.2022.809373

ISSN=2673-8740

ABSTRACT=In the follow-up of treated high-grade gliomas (HGG), differentiating true tumor progression from treatment-related effects such as pseudoprogression and radiation necrosis presents an ongoing clinical challenge. Conventional MRI with and without intravenous contrast serves as the clinical benchmark for post-treatment surveillance imaging of HGG.  However, many advanced imaging techniques have shown promise in helping better delineate findings in indeterminate scenarios, as post-treatment effects can often mimic true tumor progression on conventional imaging. These challenges are further confounded by the histologic admixture that can commonly occur between tumor growth and treatment-related effects within the post-treatment bed. This review discusses the current practices in surveillance imaging of HGG and the role for advanced imaging techniques, including perfusion MRI and metabolic MRI.