The Role of Advanced MRI Sequences in the Diagnosis and Follow-Up of Adult Brainstem Gliomas: A Neuroradiological Review

Alessia Guarnera; Andrea Romano; Giulia Moltoni; Tamara Ius; Serena Palizzi; Allegra Romano; Daniele Bagatto; Giuseppe Minniti; Alessandro Bozzao

doi:10.3390/tomography9040122

Tomography (Aug 2023)

The Role of Advanced MRI Sequences in the Diagnosis and Follow-Up of Adult Brainstem Gliomas: A Neuroradiological Review

Alessia Guarnera,
Andrea Romano,
Giulia Moltoni,
Tamara Ius,
Serena Palizzi,
Allegra Romano,
Daniele Bagatto,
Giuseppe Minniti,
Alessandro Bozzao

Affiliations

Alessia Guarnera: Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
Andrea Romano: Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
Giulia Moltoni: Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
Tamara Ius: Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
Serena Palizzi: Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
Allegra Romano: Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
Daniele Bagatto: Neuroradiology Unit, Department of Diagnostic Imaging, University Hospital of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
Giuseppe Minniti: Department of Radiological Sciences, Oncology and Anatomical Pathology, Division of Radiotherapy, La Sapienza University of Rome, 00161 Rome, Italy
Alessandro Bozzao: Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy

DOI: https://doi.org/10.3390/tomography9040122
Journal volume & issue: Vol. 9, no. 4
pp. 1526 – 1537

Abstract

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The 2021 WHO (World Health Organization) classification of brain tumors incorporated the rapid advances in the molecular, genetic, and pathogenesis understanding of brain tumor pathogenesis, behavior, and treatment response. It revolutionized brain tumor classification by placing great emphasis on molecular types and completely splitting adult-type and pediatric-type diffuse gliomas. Brainstem gliomas (BSGs) are the leading primary tumors of the brainstem, although they are quite uncommon in adults compared with the pediatric population, representing less than 2% of adult gliomas. Surgery is not always the treatment of choice since resection is rarely feasible and does not improve overall survival, and biopsies are not generally performed since the location is treacherous. Therefore, MRI (Magnetic Resonance Imaging) without and with gadolinium administration represents the optimal noninvasive radiological technique to suggest brainstem gliomas diagnosis, plan a multidisciplinary treatment and for follow-up evaluations. The MRI protocol encompasses morphological sequences as well as functional and advanced sequences, such as DWI/ADC (Diffusion-Weighted Imaging/Apparent Diffusion Coefficient), DTI (Diffusion Tensor Imaging), PWI (Perfusion-Weighted Imaging), and MRS (Magnetic Resonance Spectroscopy), which improve the accuracy of the diagnosis of BSGs by adding substantial information regarding the cellularity, the infiltrative behavior toward the v fiber tracts, the vascularity, and the molecular changes. Brainstem gliomas have been divided into four categories on the basis of their MRI radiological appearance, including diffuse intrinsic low-grade gliomas, enhancing malignant gliomas, localized tectal gliomas, and other forms. The aim of our review is to provide insight into the role of advanced MRI sequences in the diagnosis and follow-up of adult brainstem gliomas.

Published in Tomography

ISSN: 2379-1381 (Print); 2379-139X (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Medicine (General): Computer applications to medicine. Medical informatics
Website: https://www.mdpi.com/journal/tomography

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