Type:
Educational Exhibit
Keywords:
Neoplasia, Multidisciplinary cancer care, Radiation effects, Diagnostic procedure, MR-Diffusion/Perfusion, MR, Neuroradiology brain
Authors:
A. Hilario Barrio, P. Martín Medina, E. Salvador, G. Ayala, L. Koren, A. Martinez de Aragon, F. Ballenilla, J. M. Millan, A. Ramos Gonzalez; Madrid/ES
DOI:
10.26044/ecr2019/C-0185
Learning objectives
Glioblastoma is the most common primary malignant brain tumor in adults and it is associated with a dismal prognosis (median survival time of patients only 3 to 9 months after first recurrence).
Current standard of care is STUPP scheme: surgical resection followed by radiotherapy (RT) and concomitant and adjuvant temozolomide (TMZ) chemotherapy.
What are the main problems of brain tumors?
- Infiltrating tumors,
indistinct borders
- Difficult to differentiate tumor infiltration,
edema,
gliosis and post-RT changes
- Enhancement only reflects blood brain barrier (BBB) permeability
- Problems to distinguish recurrence from post-treatment changes
- New treatments produce new imaging patterns: pseudoprogression (Rt+QT,
immunotherapies...) similar to true progression
Hence,
Response Assessment in Neuro-Oncology Working Group (RANO) emerged in an attemp to provide standarized response criteria that accounts for transient changes in tumor volume post-therapy.
Fig. 2: Brain tumor problems after therapy
Our objectives were to decribe tips and tricks at MRI that help us differentiate true progression (TP) from pseudoprogression (PsP) in the follow-up of treated gliomas.