Pitfalls in the Neuroimaging of Glioblastoma in the Era of Antiangiogenic and Immuno/Targeted Therapy – Detecting Illusive Disease, Defining Response

摘要: Glioblastoma, the most common malignant primary brain tumor in adults is a devastating diagnosis with an average survival of 14-16 months using current standard care treatment. The determination treatment response and clinical decision making based on accuracy radiographic assessment. Notwithstanding, challenges exist neuroimaging evaluation patients undergoing for glioma. Differentiating from progression problematic currently combines long-term follow-up MRI, status corticosteroid-dependency assessments. In trial setting, gene therapy, vaccines, immunotherapy, targeted biologicals similarly produces MRI changes mimicking disease progression. A method to clearly distinguish between pseudoprogression has unfortunately not been found date. With incorporation antiangiogenic therapies, further pitfall imaging interpretation pseudoresponse. Macdonald Criteria that correlate burden contrast enhanced proved insufficient misleading context rapid blood barrier normalization following accompanied by expected benefit. Even improved criteria, such as RANO incorporate non-enhancing disease, status, need corticosteroid use, fall short definitively distinguishing progression, pseudoresponse, pseudoprogression. This review focuses advanced techniques including perfusion diffusion MR spectroscopy, new PET tracers. relevant image analysis algorithms methods these promising are discussed determining during glioblastoma both well context.