MRI-Based Evaluation of Tumor Response in Gliomas

Magnetic resonance imaging (MRI) is central to assessing therapeutic effects in gliomas, where distinguishing true tumour progression from treatment-related phenomena such as pseudoprogression or radiation necrosis is critical for guiding clinical decisions. Conventional sequences, including T1-weighted contrast-enhanced and T2/FLAIR imaging, are routinely combined with advanced techniques such as diffusion-weighted imaging (DWI) and dynamic susceptibility contrast (DSC) perfusion to characterise tissue cellularity and vascularity. Quantitative metrics—most notably relative cerebral blood volume (rCBV) derived from perfusion studies—help discriminate viable tumour from post-treatment changes. Multiparametric approaches integrate structural and functional information within machine-learning frameworks to improve diagnostic accuracy. Standardised assessment frameworks, such as the Response Assessment in Neuro-Oncology (RANO) criteria, incorporate these modalities to define progression and response. Recent advances focus on spatially resolved analyses, artificial-intelligence-driven feature extraction and validation of predictive models, all aimed at refining early detection of recurrence, optimising patient management and enabling more personalised therapeutic strategies.

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MRI-Based Evaluation of Tumor Response in Gliomas publication trend

The graph below shows the total number of articles in mri-based evaluation of tumor response in gliomas across all publications each year (not limited to Nature Index journals).

Technical terms

Pseudoprogression: A transient increase in contrast enhancement or oedema on MRI following radiotherapy or chemoradiotherapy that mimics tumour growth but subsequently stabilises or regresses without a change in treatment.

True progression: Sustained enlargement of enhancing lesions or new lesion development on serial MRI, consistent with active tumour growth rather than treatment effect.

Relative cerebral blood volume (rCBV): A perfusion MRI metric expressing the volume of blood in a given brain region relative to normal tissue; elevated rCBV suggests neovascularisation typical of recurrent tumour.

Diffusion-weighted imaging (DWI): An MRI technique sensitive to the Brownian motion of water molecules; restricted diffusion often correlates with high cellular density in viable tumour.

Dynamic susceptibility contrast (DSC) perfusion: A method that tracks signal changes during rapid bolus injection of contrast agent to quantify cerebral blood volume and flow, aiding in differentiation of treatment-related changes from recurrence.

References

1. Treatment-associated imaging changes in newly diagnosed MGMT promoter-methylated glioblastoma undergoing chemoradiation with or without cilengitide. Neuro-Oncology (2024).
2. Resolving spatial response heterogeneity in glioblastoma. European Journal of Nuclear Medicine and Molecular Imaging (2024).
3. Validation of multiparametric MRI based prediction model in identification of pseudoprogression in glioblastomas. Journal of Translational Medicine (2023).
4. Response Assessment in Neuro-Oncology Criteria for Gliomas: Practical Approach Using Conventional and Advanced Techniques. American Journal of Neuroradiology (2019).
5. Relative Cerebral Blood Volume Values to Differentiate High-Grade Glioma Recurrence from Posttreatment Radiation Effect: Direct Correlation between Image-Guided Tissue Histopathology and Localized Dynamic Susceptibility-Weighted Contrast-Enhanced Perfusion MR Imaging Measurements. American Journal of Neuroradiology (2008).
6. Diffusion and Perfusion MRI to Differentiate Treatment-Related Changes Including Pseudoprogression from Recurrent Tumors in High-Grade Gliomas with Histopathologic Evidence. American Journal of Neuroradiology (2015).