ISMRM22 - Brain Tumors: From Molecules to MRI

Joint Annual Meeting ISMRM-ESMRMB & ISMRT 31st Annual Meeting • 07-12 May 2022 • London, UK

Brain Tumors: From Molecules to MRI

Weekend Course

ORGANIZERS: Anja van der Kolk, Takashi Abe, Seena Dehkharghani

Saturday, 07 May 2022

S11 (Breakout A)

13:00 - 17:00

Moderators:
Static Molecules: CEST, MRS & X-Nuclei Imaging: Evita Wiegers
Moving Molecules: Perfusion & Diffusion: Brent Weinberg

Skill Level: Basic to Intermediate

Session Number: WE-08

Session Number: WE-08

Overview
Recent years have seen a paradigm shift in diagnosing brain tumors, from "simple" histopathology to a complex interplay between histopathology and genetic and molecular features, first introduced with the 2016 WHO Brain Tumor classification. Since that time, molecular features of brain tumors have become key players in neuro-oncology, affecting the way we treat patients with brain tumors and improving our survival models. While primary diagnosis is still based on tissue assessment, several noninvasive MRI techniques have shown promise in non-invasively classifying brain tumors, and some are even used regularly in the clinic. In this session, we will review the new 2021 WHO classification and what this means for clinical practice, as well as how we can use conventional and advanced MRI techniques to address the molecular features underlying this classification. In addition, novel and promising MRI techniques to diagnose and monitor brain tumors will be discussed, as well as the challenges we face in the treated brain tumor, both from a clinical as well as a physics perspective.

Target Audience
Everyone interested in brain tumors, from their genetic and molecular foundation via diagnosis to treatment, and the role MRI can play (and already plays) in patients with brain tumors.

Educational Objectives
As a result of attending this course, participants should be able to:
- Describe the basics of the 2021 WHO Brain Tumor Classification;
- Identify molecular and other aspects of brain tumors that could potentially be targeted with MRI;
- Summarize both advantages and challenges of conventional MRI in diagnosing brain tumors;
- Explain the most promising advanced MRI sequences for brain tumor diagnosis;
- Name the latest MRI applications being developed for probing the brain tumor environment; and
- Explain the impact of treatment on MR imaging of brain tumors.

	Current State of Brain Tumor Diagnosis
13:00		Genes & Molecules: Why Should We Care? TBD
13:25		Brain Tumors: A Tour of Current Clinical Practice View the Presentation Mai-Lan Ho This lecture will cover the imaging spectrum of adult and pediatric brain tumors with rich clinical case material, implementation of quantitative and advanced MRI techniques, and practical tips regarding diagnostic pearls and pitfalls. In addition, we will review key molecular pathways and genomic signatures relevant to patient diagnosis and management. Finally, we will introduce the concept of imaging genomics with examples of genotype-phenotype correlation, radiogenomics and deep learning, and emerging theranostic approaches.
	Moving Molecules: Perfusion & Diffusion
13:50		Perfusion MRI: How to Choose Between (& Within) Techniques View the Presentation C. Chad Quarles The overall purpose of this educational lecture is to discuss perfusion imaging options for brain tumor imaging. Topics will include protocol design informed by contrast mechanisms, sensitivity, and clinical utility. Emerging perfusion imaging techniques and their potential to aid in clinical decisions will also be discussed.
14:15		Diffusion Within the Tumor Microenvironment View the Presentation Markus Nilsson This lecture will explain the link between tumor microstructure and the different parameters that we can observe with diffusion MRI.
14:40		Break & Meet the Teachers
	Static Molecules: CEST, MRS & X-Nuclei Imaging
15:05		How to Measure Molecules in Brain Tumors & Why View the Presentation Brent Weinberg, Hyunsuk Shim Brain tumors are a challenging diagnosis that depend heavily on imaging, but routine MRI sequences including diffusion (DWI), FLAIR, and post-contrast T1 have their limitations. MRS has the capability to measure molecular concentrations non-invasively and without a contrast injection. Whole brain spectroscopic MRI (sMRI) has the potential to improve the clinical impact of MR spectroscopy on diagnosis and treatment of brain tumors by guiding surgical and radiation management in a way that can improve patient outcomes. Future developments may bring further applications of this technology beyond brain tumors and into other categories of disease.
15:30		X-Nuclei Imaging in Brain Tumors View the Presentation Tanja Platt Physiologically relevant nuclei that enable MR applications ('X-nuclei') in tumor imaging in addition to hydrogen (¹H) will be presented and the special MR characteristics of these nuclei will be explained. X-nuclei MR applications offer a wide variety of applications in science and translational research. Here, an overview of the physical MR properties of these nuclei and clinical research applications in brain tumor imaging will be given.
	Update on Treatment Options & How These Affect What We See on MRI
15:55		Treating Brain Tumors: What Can We Do (& Where Do We Still Fail) View the Presentation Manabu Kinoshita Surgical impact on overall survival for IDH-mutant tumors is much more significant than IDH-wildtype tumors. Thus, the role of neuroimaging is different between these two diseases. It is crucial to predict the presence or absence of IDH mutation, as it has a significant influence on the surgical strategies of the tumor. On the other hand, it is still difficult to fully visualize the full extension of the disease for IDH-wildtype tumors, which hinders planning the most efficient radiotherapy. The author would like to provide an overview of the current standard treatment strategies for gliomas, referring to the role of neuroimaging.
16:20		Challenges in Imaging Treated Brain Tumors View the Presentation Yae Won Park The accurate assessment of glioma disease status is challenging due to the complex combination of therapies and treatment-related changes, along with the sometimes ambiguous and overlapping imaging findings. The history of response assessment in glioma – Macdonald, RANO, and mRANO – will be introduced and discussed. The posttreatment imaging findings, including pseudoprogression, radiation necrosis, pseudoresponse, and true progression, will be discussed. In short, this lecture will endeavor to aid the real-world imaging interpretation situation, where us radiologists must make our own decision on the posttreatment glioma MRI with the accessible information, and give the clinicians a satisfying answer.