Standard clinical approaches and emerging modalities for glioblastoma imaging
Joshua D. Bernstock, Sam E. Gary, Neil V. Klinger, Pablo A. Valdés, Walid Ibn Essayed, Hannah E. Olsen, Gustavo Chagoya, Galal Elsayed, Daisuke Yamashita, Patrick Schuss, Florian Geßler, Pier Paolo Peruzzi, Asim K. Bag, Gregory K. Friedman
Abstract
Glioblastoma (GBM) is the most common primary adult intracranial malignancy and carries a dismal prognosis despite an aggressive multimodal treatment regimen that consists of surgical resection, radiation, and adjuvant chemotherapy. Radiographic evaluation, largely informed by magnetic resonance imaging (MRI), is a critical component of initial diagnosis, surgical planning, and post-treatment monitoring. However, conventional MRI does not provide information regarding tumor microvasculature, necrosis, or neoangiogenesis. In addition, traditional MRI imaging can be further confounded by treatment-related effects such as pseudoprogression, radiation necrosis, and/or pseudoresponse(s) that preclude clinicians from making fully informed decisions when structuring a therapeutic approach. A myriad of novel imaging modalities have been developed to address these deficits. Herein, we provide a clinically oriented review of standard techniques for imaging GBM and highlight emerging technologies utilized in disease characterization and therapeutic development.