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  • Review Article
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Functional imaging in adult and paediatric brain tumours

Nature Reviews Clinical Oncology volume 9, pages 700–711 (2012)Cite this article

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Abstract

Imaging is a key component in the management of brain tumours, with MRI being the preferred modality for most clinical scenarios. However, although conventional MRI provides mainly structural information, such as tumour size and location, it leaves many important clinical questions, such as tumour type, aggressiveness and prognosis, unanswered. An increasing number of studies have shown that additional information can be obtained using functional imaging methods (which probe tissue properties), and that these techniques can give key information of clinical importance. These techniques include diffusion imaging, which can assess tissue structure, and perfusion imaging and magnetic resonance spectroscopy, which measures tissue metabolite profiles. Tumour metabolism can also be investigated using PET, with 18F-deoxyglucose being the most readily available tracer. This Review discusses these methods and the studies that have investigated their clinical use. A strong emphasis is placed on the measurement of quantitative parameters, which is a move away from the qualitative nature of conventional radiological reporting and presents major challenges, particularly for multicentre studies.

Key Points

  • Conventional imaging gives information largely on tumour structure and location and is increasingly being supplemented by methods that probe tissue properties, commonly referred to by the collective term 'functional imaging'

  • A range of functional imaging techniques for brain tumours that provide information on cellularity, tissue ultrastructure, metabolism and vascularity are available and best acquired as part of a multimodal protocol

  • Increasing evidence shows that these techniques can aid diagnosis, provide noninvasive prognostic biomarkers, help treatment planning and monitor the treatment of brain tumours

  • Challenges remain in determining the optimum manner for incorporating these techniques into routine clinical practice, and robust data for their role should be obtained from multicentre clinical trials

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Figure 1: ADC maps of tumours with different cellular density.
Figure 2: DTI in a patient with glioblastoma in the right hemisphere.
Figure 3: 1H MRS of normal brain (basal ganglia).
Figure 4: PET image slices of [methyl-11C]temozolomide in a patient with glioma.112
Figure 5: Magnetic resonance spectroscopy as a noninvasive diagnostic aid.
Figure 6: MRSI showing regional metabolite variation in a heterogeneous tumour.
Figure 7: Citrate as a marker of poor prognosis in grade II astrocytomas.
Figure 8: Distinguishing tumour relapse from pseudoprogression.

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Acknowledgements

A. C. Peet, T. N. Arvanitis and M. O. Leach would like to acknowledge funding from the Cancer Research UK and Engineering and Physical Sciences Research Council Cancer Imaging Programme at the Children's Cancer and Leukaemia Group in association with the Medical Research Council and Department of Health (England) (C7809/A10342). A. D. Waldman would like to acknowledge the support of Imperial College Comprehensive Biomedical Research Centre. We would like to thank the members of the Brain Tumour Research Group at the University of Birmingham who helped to prepare figures for the manuscript.

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Authors and Affiliations

  1. Cancer Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK

    Andrew C. Peet

  2. School of Electronic, Electrical and Computer Engineering, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK

    Theodoros N. Arvanitis

  3. Institute of Cancer Research, Sutton, 15 Cotswold Road, Belmont, Sutton, SM2 5NG, Surrey, UK

    Martin O. Leach

  4. Imperial College London, Exhibition Road, London, SW7 2AZ, UK

    Adam D. Waldman

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All authors researched the data for the article, provided a substantial contribution to discussions of the content, contributed equally to writing the article and to review and/or editing of the manuscript before submission.

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Correspondence to Andrew C. Peet.

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Peet, A., Arvanitis, T., Leach, M. et al. Functional imaging in adult and paediatric brain tumours. Nat Rev Clin Oncol 9, 700–711 (2012). https://doi.org/10.1038/nrclinonc.2012.187

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