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Cited by 14Glioma Diagnosis and TreatmentAdvanced Neuroimaging Techniques and ApplicationsAdvanced MRI Techniques and Applications

Advances of MR imaging in glioma: What the neurosurgeon needs to know

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Falk Delgado, Anna·2025·Acta Neurochirurgica
DOI 10.1007/s00701-025-06593-6PMC PMC12182469
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Abstract

Glial tumors and especially glioblastoma present a major challenge in neuro-oncology due to their infiltrative growth, resistance to therapy, and poor overall survival—despite aggressive treatments such as maximal safe resection and chemoradiotherapy. These tumors typically manifest through neurological symptoms such as seizures, headaches, and signs of increased intracranial pressure, prompting urgent neuroimaging. At initial diagnosis, MRI plays a central role in differentiating true neoplasms from tumor mimics, including inflammatory or infectious conditions. Advanced techniques such as perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) enhance diagnostic specificity and may prevent unnecessary surgical intervention. In the preoperative phase, MRI contributes to surgical planning through the use of functional MRI (fMRI) and diffusion tensor imaging (DTI), enabling localization of eloquent cortex and white matter tracts. These modalities support safer resections by informing trajectory planning and risk assessment. Emerging MR techniques, including magnetic resonance spectroscopy, amide proton transfer imaging, and 2HG quantification, offer further potential in delineating tumor infiltration beyond contrast-enhancing margins. Postoperatively, MRI is important for evaluating residual tumor, detecting surgical complications, and guiding radiotherapy planning. During treatment surveillance, MRI assists in distinguishing true progression from pseudoprogression or radiation necrosis, thereby guiding decisions on additional surgery, changes in systemic therapy, or inclusion into clinical trials. The continued evolution of MRI hardware, software, and image analysis—particularly with the integration of machine learning—will be critical for supporting precision neurosurgical oncology. This review highlights how advanced MRI techniques can inform clinical decision-making at each stage of care in patients with high-grade gliomas.

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  • Restricted diffusion is often associated with hypercellularity, but ADC is also influenced by edema, necrosis, hemorrhage, microvascular architecture, and intratumoral heterogeneity.

    “Restricted diffusion is often associated with hypercellularity, but ADC is also influenced by edema, necrosis, hemorrhage, microvascular architecture, and intratumoral heterogeneity (Falk Delgado, 2025).”

    From 40 Years of diffusion MRI in the brain: From history to emerging frontiers (2026) · cites this paper as Falk Delgado, 2025

    The Diffusion weighted imaging (DWI) section (page unavailable) links low ADC and restricted diffusion to densely packed tumor cells, and notes diffusion differences between infiltrative tumor and vasogenic edema. It also describes effects of tissue microstructure on diffusion and blood products on DWI image quality. It does not establish that necrosis, microvascular architecture, or intratumoral heterogeneity influence ADC, or that hemorrhage directly changes ADC. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Falk Delgado, A.
Venue
Acta Neurochirurgica
Publisher
Springer Science and Business Media LLC
Published
2025-06-21
Volume
167
Issue
1
Pages
174-174
ISSN
  • 0001-6268 (ISSN-L)
  • 0942-0940
DOI
10.1007/s00701-025-06593-6
PMC
PMC12182469
OpenAlex
W4411504571
Cited by
14
References
1
Citations by year
2026: 9 · 2025: 5
FWCI
2.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Acta Neurochirurgica (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Supported by grants provided by the Stockholm County Council, Wibergs foundation, Magnus Bergvall foundation, The Swedish Society of Medicine, Matsumurai foundation, KI funds.
  • Karolinska Institute
Topics
  • Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
Keywords
glioma, glioblastoma, high-grade glioma, neuroimaging, perfusion MRI, diffusion-weighted imaging, functional MRI, diffusion tensor imaging, magnetic resonance spectroscopy, amide proton transfer imaging, tumor infiltration, surgical planning, residual tumor assessment, pseudoprogression, radiation necrosis, machine learning, neurosurgical oncology
MeSH terms
Brain Neoplasms, Glioma, Humans, Magnetic Resonance Imaging, Neuroimaging

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