Modern preoperative imaging and functional mapping in patients with intracranial glioma

Abstract

Magnetic resonance imaging (MRI) in therapy-naïve intracranial glioma is paramount for neuro-oncological diagnostics, and it provides images that are helpful for surgery planning and intraoperative guidance during tumor resection, including assessment of the involvement of functionally eloquent brain structures. This study reviews emerging MRI techniques to depict structural information, diffusion characteristics, perfusion alterations, and metabolism changes for advanced neuro-oncological imaging. In addition, it reflects current methods to map brain function close to a tumor, including functional MRI and navigated transcranial magnetic stimulation with derived function-based tractography of subcortical white matter pathways. We conclude that modern preoperative MRI in neuro-oncology offers a multitude of possibilities tailored to clinical needs, and advancements in scanner technology (e. g., parallel imaging for acceleration of acquisitions) make multi-sequence protocols increasingly feasible. Specifically, advanced MRI using a multi-sequence protocol enables noninvasive, image-based tumor grading and phenotyping in patients with glioma. Furthermore, the add-on use of preoperatively acquired MRI data in combination with functional mapping and tractography facilitates risk stratification and helps to avoid perioperative functional decline by providing individual information about the spatial location of functionally eloquent tissue in relation to the tumor mass.

Key Points: 

• Advanced preoperative MRI allows for image-based tumor grading and phenotyping in glioma.

• Multi-sequence MRI protocols nowadays make it possible to assess various tumor characteristics (incl. perfusion, diffusion, and metabolism).

• Presurgical MRI in glioma is increasingly combined with functional mapping to identify and enclose individual functional areas.

• Advancements in scanner technology (e. g., parallel imaging) facilitate increasing application of dedicated multi-sequence imaging protocols.

Citation Format

• Sollmann N, Zhang H, Kloth C et al. Modern preoperative imaging and functional mapping in patients with intracranial glioma. Fortschr Röntgenstr 2023; 195: 989 – 1000

Zusammenfassung

Der Magnetresonanztomografie (MRT) bei unbehandelten intrakraniellen Gliomen kommt entscheidende Bedeutung im Rahmen der neuroonkologischen Diagnostik zu, während die MRT-Bildgebung zum Zeitpunkt vor einer neurochirurgischen Tumorresektion zudem Bilddaten liefert, welche die chirurgische Planung und das intraoperative Vorgehen unterstützen können und insbesondere Rückschlüsse auf eine mögliche Beteiligung funktionell eloquenter Strukturen zulassen. Die vorliegende Arbeit stellt aktuell aufkommende MRT-basierte Techniken vor, welche eine Darstellung von strukturellen und diffusionsbasierten Charakteristika sowie Perfusionsveränderungen und Alterationen des Metabolismus im neuroonkologischen Zusammenhang ermöglichen. Darüber hinaus stellt sie fortschrittliche Methoden zur Kartierung von Gehirnfunktionen in Nachbarschaft eines Tumors vor unter Einbezug der funktionellen MRT sowie der navigierten transkraniellen Magnetstimulation und funktionsbasierten Traktografie von subkortikalen Faserbahnen der weißen Substanz. Zusammenfassend eröffnet die moderne präoperative MRT-Bildgebung in der Neuroonkologie eine wachsende Bandbreite an Möglichkeiten gemäß der individuellen klinischen Anforderungen, wobei Weiterentwicklungen im Bereich der Scanner-Technologie (z. B. parallele Bildgebung zur Beschleunigung der Bildakquisition) auch Protokolle mit einer zunehmenden Anzahl von Sequenzen möglich machen. Im Speziellen erlaubt eine fortschrittliche MRT-Bildgebung mittels multisequenzieller Protokolle eine nichtinvasive, bildbasierte Tumorklassifikation und Phänotypisierung bei Patienten mit Gliomen. Des Weiteren ermöglicht die zusätzliche Verwendung präoperativer MRT-Bildgebung in Kombination mit funktioneller Kartierung und Traktografie eine Risikostratifizierung und hilft bei der Vermeidung perioperativer funktioneller Defizite, da individuelle Informationen über die räumliche Lokalisation funktionell eloquenter Strukturen in Relation zum Tumor bereitgestellt werden können.

Kernaussagen: 

• Moderne präoperative MRT-Bildgebung ermöglicht eine bildgestützte Tumorklassifikation und Phänotypisierung bei Gliomen.

• Bildgebungsprotokolle mit vielfältigen Sequenzen können heutzutage eine Darstellung verschiedenster Tumorcharakteristika gewährleisten (inkl. Perfusion, Diffusion sowie Metabolismus).

• Präoperative MRT-Bildgebung bei Gliomen wird zunehmend mit funktioneller Kartierung zur Identifikation und Abgrenzung individueller funktioneller Areale kombiniert.

• Weiterentwicklungen der Scanner-Technologie (z. B. parallele Bildgebung) können zu einer weiter verbreiteten Anwendung spezifischer multisequenzieller Bildgebungsprotokolle beitragen.

Key words

glioma - preoperative mapping - functional mapping - magnetic resonance imaging - navigated transcranial magnetic stimulation - tractography

Publication History

Received: 23 July 2021

Accepted: 18 April 2023

Article published online:
24 May 2023

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