Imaging techniques are important for accurate diagnosis and follow-up of patients with gliomas. T1-weighted MRI, with or without gadolinium, is the gold standard method. However, this technique only reflects biological activity of the tumour indirectly by detecting the breakdown of the blood-brain barrier. Therefore, especially for low-grade glioma or after treatment, T1-weighted MRI enhanced with gadolinium has substantial limitations. Development of more advanced imaging methods to improve outcomes for individual patients is needed. New imaging methods based on MRI and PET can be employed in various stages of disease to target the biological activity of the tumour cells (eg, increased uptake of aminoacids or nucleoside analogues), the changes in diffusivity through the interstitial space (diffusion-weighted MRI), the tumour-induced neovascularisation (perfusion-weighted MRI or contrast-enhanced MRI, or increased uptake of aminoacids in endothelial wall), and the changes in concentrations of metabolites (magnetic resonance spectroscopy). These techniques have advantages and disadvantages, and should be used in conjunction to best help individual patients. Advanced imaging techniques need to be validated in clinical trials to ensure standardisation and evidence-based implementation in routine clinical practice.

3' fluorothymidine f 18, amino acid, blood brain barrier, cancer grading, cancer radiotherapy, clinical assessment, clinical trial, concentration (parameters), diffusion weighted imaging, disease activity, disease course, drug uptake, evidence based practice, fluorodeoxyglucose f 18, gadolinium, glioma, human, membrane permeability, metabolite, methionine c 11, neovascularization (pathology), nuclear magnetic resonance imaging, nuclear magnetic resonance spectroscopy, nucleoside analog, positron emission tomography, priority journal, radiation necrosis, review, temozolomide, treatment response, tumor cell, validation study,
The Lancet Neurology
Erasmus MC: University Medical Center Rotterdam

Dhermain, F.G, Hau, P, Lanfermann, H, Jacobs, A.H, & van den Bent, M.J. (2010). Advanced MRI and PET imaging for assessment of treatment response in patients with gliomas. The Lancet Neurology (Vol. 9, pp. 906–920). doi:10.1016/S1474-4422(10)70181-2