Neuroimaging

Neuroimaging plays a crucial role in establishing the diagnosis, planning the therapy, as well as evaluating therapeutic effects and detecting early recurrence in brain tumors. It has evolved from a morphology-driven discipline to the multimodal assessment of CNS lesions, incorporating biochemistry (e.g., indicators of cell membrane synthesis) as well as physiologic parameters (e.g., hemodynamic variables).

Tumor cellularity, metabolism, and angiogenesis are important predictors for tumor grading, therapy, and prognosis, all of which are provided by dedicated use of advanced magnetic resonance imaging (MRI) techniques by the neuroradiologist.

Unprecedented views of tumor-affected brain cytoarchitecture are yielded by diffusion tensor imaging and tractography, discriminating between displacement and infiltration of highly relevant white matter tracts and guiding the neurosurgeon's CNS approach.

Functional MRI (fMRI) visualizes the spatial relationship between functionally important areas and the tumor site.

Many of these techniques use superimposition on high-anatomic-resolution MR images within the submillimeter range, in order to assure precise stereotactic proceedings. Yet, the borders of neuroimaging are subject to constant updating.

Molecular imaging has become one of the most promising research areas, as the molecular fingerprint of the tumor is required for targeting chemotherapy-resistant, migrating glial tumor cells.