Structural, Metabolic and Physiologic MR Imaging to Study Glioblastomas

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Background

Glioblastoma (GBM), a devastating and life-threatening disease, is the most common primary malignant brain neoplasm representing 30% of all central nervous system tumors in adults. Proton magnetic resonance (MR) spectroscopy, and diffusion and perfusion MR imaging are widely accessible and more commonly used metabolic and physiologic imaging techniques in the field of clinical neuro-oncology. These techniques have shown great potential in shedding light on tumor biology and molecular profiles of GBMs, leading to improved diagnosis and characterization of these aggressive and heterogenous neoplasms. Despite multimodal first-line treatment that includes surgery, radiation therapy, and chemotherapy, the prognosis of GBM patients is dismal, with a 5-year survival rate of about 5% and a median overall survival of only 14-16 months following diagnosis.

Due to continuation in the quest for an effective treatment, the therapeutic armamentarium has grown significantly over the past decade. Newly tested treatment strategies include: the addition of bevacizumab, modified temozolomide dosing, targeted molecular therapies, gene therapies, and a variety of immunotherapies such as check point inhibitors, chimeric antigen T cell receptors, and dendritic cell vaccines. However, these new treatment modalities trigger new imaging patterns of tumor progression, pseudo response, and predominant treatment related changes, also known as pseudo-progression and radiation necrosis. RANO (Response Assessment in Neuro‐Oncology) criteria based on conventional neuroimaging findings are often equivocal in the post-therapy response assessment and present a considerable diagnostic challenge due to the lack of specificity. On the other hand, several novel advanced MR imaging biomarkers are continuously being developed to evaluate the treatment response with high reliability and accuracy. Taken together, advanced MR imaging techniques supplement standard MR imaging findings with a wealth of information and thus provide new avenues to diagnose and monitor the treatment of GBMs.

The aim of this Research Topic is to bring researchers, scientists, clinicians, and radiologists to the discussion of the potential clinical utilities of MR imaging biomarkers, existing challenges and limitations of using advanced techniques in characterizing GBMs, and evaluating treatment response in these patients. We welcome investigators to contribute Original Research and/or Review Articles.

Potential topics include, but are not limited to:

• Differential diagnosis of tumor from non-neoplastic lesions using advanced imaging techniques
• Diagnostic potential of metabolic and physiologic MR imaging techniques in differentiating GBMs, brain lymphomas and brain metastases
• Distinction of GBMs from low grade gliomas
• Potential clinical applications of advanced MR imaging techniques in identification of molecular signatures in GBMs
• Identification of occult neoplastic infiltration into normal brain parenchyma
• Radiomics and Radiogenomic signatures for characterization of GBMs
• Delineation of a target volume for radiation therapy planning
• Evaluating treatment response to standard-of-care and novel treatment therapies

Keywords: Glioblastoma; Treatment, Surgery, Chemoradiation therapy, Immunotherapy; MR Imaging; MR Spectroscopy; Diffusion MR Imaging; Perfusion MR Imaging; Radiomics; Radio-genomics

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