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The value of metabolic imaging in diagnosis and resection of cerebral gliomas

Nature Clinical Practice Neurology volume 1, pages 62–63 (2005)Cite this article

The advent of computed tomography in the 1970s heralded a new age in the diagnosis and therapy of brain tumors, and the introduction of magnetic resonance tomography had a similar impact in the 1980s and 1990s. In parallel, modes of imaging that rely on the metabolic characteristics of tissues have been developed, some with their roots in nuclear medicine, and some based on MRI. There is a strong scientific interest in these methods, but their value in the day-to-day treatment of patients with brain tumors has not yet been fully evaluated.

What can current metabolic imaging techniques offer that standard MRI cannot? Signal abnormalities on GADOLINIUM-enhanced MRI are unreliable both for distinguishing between neoplastic and non-neoplastic lesions and for separating 'low-grade' (WHO GRADE II) from 'high-grade' (WHO grade III and IV) gliomas. In light of the known regional heterogeneity of gliomas, basing the selection of biopsy sites, resection planning, judgment of therapy success and diagnosis of tumor relapse on MRI abnormalities alone carries a risk of taking tissue samples that are diagnostically nonspecific or are not representative of the entire lesion. Furthermore, although resection planning of malignant gliomas relies on MRI data, enhancing tumor regions are difficult to distinguish intraoperatively. Tools such as neuronavigation and intraoperative MRI have been developed to integrate MRI data into surgical procedures; however, neuronavigation is hampered by the phenomenon of intraoperative brain shift, and intraoperative MRI is cumbersome and expensive. Metabolic imaging might provide a solution to these problems.

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  1. consultants in neurosurgery at the University of Düsseldorf Department of Neurosurgery, Düsseldorf, Germany

    Frank Willi Floeth & Walter Stummer

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  1. Frank Willi Floeth
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Correspondence to Frank Willi Floeth.

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Floeth, F., Stummer, W. The value of metabolic imaging in diagnosis and resection of cerebral gliomas. Nat Rev Neurol 1, 62–63 (2005). https://doi.org/10.1038/ncpneuro0043

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