Neuro-Oncology Imaging and Response Assessment

Neuro-oncology imaging encompasses a spectrum of magnetic resonance modalities and advanced computational techniques to characterise brain tumours, guide therapy and appraise treatment efficacy. Conventional sequences such as T1-weighted imaging with and without gadolinium-based contrast agents, T2-weighted imaging and fluid-attenuated inversion recovery provide anatomical delineation of enhancing and non-enhancing tumour compartments, oedema and treatment-related changes. Response assessment has evolved from one- and two-dimensional diameter measurements to three-dimensional volumetric analysis, enabling more precise quantification of tumour burden and morphological dynamics. Criteria such as the Response Assessment in Neuro-Oncology (RANO) guidelines integrate volumetric thresholds, corticosteroid dosing and clinical status to distinguish true progression from pseudoprogression or pseudoresponse. The integration of diffusion and perfusion imaging further refines assessment of cellularity and vascular permeability, while radiomic and deep-learning approaches extract quantitative feature sets to predict survival, molecular subtype and therapeutic response. Synthetic contrast generation through neural networks offers a route to reduce reliance on repeated contrast administration, and segmentation models trained on incomplete clinical datasets facilitate large-scale retrospective analyses. Together, these innovations underpin a shift towards personalised management, improved trial endpoints and global standardisation of imaging biomarkers in both adult and paediatric neuro-oncology cohorts.

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Neuro-Oncology Imaging and Response Assessment publication trend

The graph below shows the total number of articles in neuro-oncology imaging and response assessment across all publications each year (not limited to Nature Index journals).

Technical terms

Contrast-enhanced T1-weighted MRI: Sequence acquired after intravenous gadolinium administration to highlight areas of blood–brain barrier disruption and tumour neovascularity.

T2-weighted MRI: Sequence sensitive to fluid content, used to visualise oedema and non-enhancing tumour margins.

Fluid-attenuated inversion recovery (FLAIR): Sequence that suppresses cerebrospinal fluid signal to enhance detection of peritumoral and infiltrative changes.

RANO criteria: Consensus guidelines for standardised response and progression assessment in brain tumours, integrating size thresholds, clinical status and steroid use.

Volumetric segmentation: Three-dimensional delineation of tumour compartments to quantify changes in lesion volume over time.

References

1. Glioblastoma and radiotherapy: A multicenter AI study for Survival Predictions from MRI (GRASP study). Neuro-Oncology (2024).
2. Brain tumour segmentation with incomplete imaging data. Brain Communications (2023).
3. Evaluation of RANO Criteria for the Assessment of Tumor Progression for Lower-Grade Gliomas. Cancers (2023).
4. Deep-learning-based synthesis of post-contrast T1-weighted MRI for tumour response assessment in neuro-oncology: a multicentre, retrospective cohort study. The Lancet Digital Health (2021).