Advanced Imaging Techniques for Radiotherapy Planning of Gliomas

Simple Summary Conventional magnetic resonance imaging (MRI) sequences have known limitations in target delineation for radiation treatment (RT) planning of cerebral gliomas. Advanced physiology-based MRI techniques and radionuclide imaging techniques, including positron emission tomography (PET) with amino acid radiopharmaceuticals, may increase the specificity for glioma tissue characterization. Our work aims to provide a comprehensive review of the advanced MRI and PET imaging modalities that can complement conventional MRI for RT planning of gliomas. A detailed overview of their basic principles and clinical results is given based on the most updated literature. The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current standard imaging modality for target volume delineation of gliomas. However, conventional sequences have limited capability to discriminate treatment-related changes from viable tumors, owing to the low specificity of increased blood-brain barrier permeability and peritumoral edema. Advanced physiology-based MRI techniques, such as MR spectroscopy, diffusion MRI and perfusion MRI, have been developed for the biological characterization of gliomas and may circumvent these limitations, providing additional metabolic, structural, and hemodynamic information for treatment planning and monitoring. Radionuclide imaging techniques, such as positron emission tomography (PET) with amino acid radiopharmaceuticals, are also increasingly used in the workup of primary brain tumors, and their integration in RT planning is being evaluated in specialized centers. This review focuses on the basic principles and clinical results of advanced MRI and PET imaging techniques that have promise as a complement to RT planning of gliomas.