Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

Abstract

ObjectivesAt a European Society of Neuroradiology (ESNR) Annual Meeting 2015 workshop, commonalities in practice, current controversies and technical hurdles in glioma MRI were discussed. We aimed to formulate guidance on MRI of glioma and determine its feasibility, by seeking information on glioma imaging practices from the European Neuroradiology community.MethodsInvitations to a structured survey were emailed to ESNR members (n=1,662) and associates (n=6,400), European national radiologists’ societies and distributed via social media.ResultsResponses were received from 220 institutions (59% academic). Conventional imaging protocols generally include T2w, T2-FLAIR, DWI, and pre- and post-contrast T1w. Perfusion MRI is used widely (85.5%), while spectroscopy seems reserved for specific indications. Reasons for omitting advanced imaging modalities include lack of facility/software, time constraints and no requests. Early postoperative MRI is routinely carried out by 74% within 24–72 h, but only 17% report a percent measure of resection. For follow-up, most sites (60%) issue qualitative reports, while 27% report an assessment according to the RANO criteria. A minority of sites use a reporting template (23%).ConclusionClinical best practice recommendations for glioma imaging assessment are proposed and the current role of advanced MRI modalities in routine use is addressed.Key Points• We recommend the EORTC-NBTS protocol as the clinical standard glioma protocol.• Perfusion MRI is recommended for diagnosis and follow-up of glioma.• Use of advanced imaging could be promoted with increased education activities.• Most response assessment is currently performed qualitatively.• Reporting templates are not widely used, and could facilitate standardisation.Electronic supplementary materialThe online version of this article (10.1007/s00330-018-5314-5) contains supplementary material, which is available to authorized users.

Perfusion MRI in treatment evaluation of glioblastomas: Clinical relevance of current and future techniques

“…DSC is the most widely applied perfusion method . DSC is acquired with rapid echo planar imaging (EPI) and relies on a drop in signal after passage of a gadolinium‐based contrast bolus .…”

“…However, not all techniques are widely available. Two recent large international surveys were conducted among members of the American Society of Neuroradiology (ASNR) and European Society of Neuroradiology (ESNR) . Out of 195 institutions included in the ASNR survey, 151 offered perfusion MRI and 87% thereof included perfusion MRI in their standard neuro‐oncology imaging protocol.…”

“…Specifically for evaluating the presence of pseudoprogression and pseudoresponse, these percentages were 96% and 66%, respectively . Results from the ESNR survey on glioma imaging practices in 220 institutions among 31 European countries showed that perfusion MRI is commonly utilized among European centers; perfusion MRI was implemented in the standard imaging protocol in 48% of the centers . In both surveys, DSC was shown to be the most employed perfusion method (87% and 82% for the ASNR and ESNR, respectively) followed by DCE (41% and 29%) and ASL (35% and 12%) .…”

“…Results from the ESNR survey on glioma imaging practices in 220 institutions among 31 European countries showed that perfusion MRI is commonly utilized among European centers; perfusion MRI was implemented in the standard imaging protocol in 48% of the centers . In both surveys, DSC was shown to be the most employed perfusion method (87% and 82% for the ASNR and ESNR, respectively) followed by DCE (41% and 29%) and ASL (35% and 12%) . However, only half of the centers that performed perfusion imaging performed quantitative analysis.…”

Association of Glioma Grading With Inflow‐Based Vascular‐Space‐Occupancy MRI: A Preliminary Study at 3T

“…GLIOMA is a typical brain tumor that relies on angiogenesis to grow and invade . Conventional magnetic resonance imaging (MRI) is the preferred modality for morphological evaluation of brain tumor but fails to provide information on tumor angiogenesis . Perfusion‐weighted MRI is able to provide sensitive indicators of the degree of neovascularization of gliomas, which are good predictors of glioma grade .…”