Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Aug;28(8):3306-3317.
doi: 10.1007/s00330-018-5314-5. Epub 2018 Mar 13.

Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

S C Thust  1   2   3 , S Heiland  4 , A Falini  5 , H R Jäger  1   2   3 , A D Waldman  6 , P C Sundgren  7   8 , C Godi  5 , V K Katsaros  9   10   11 , A Ramos  12 , N Bargallo  13   14 , M W Vernooij  15   16 , T Yousry  1 , M Bendszus  4 , M Smits  17
Affiliations
Multicenter Study

Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

S C Thust et al. Eur Radiol. 2018 Aug.

Abstract

Objectives: At a European Society of Neuroradiology (ESNR) Annual Meeting 2015 workshop, commonalities in practice, current controversies and technical hurdles in glioma MRI were discussed. We aimed to formulate guidance on MRI of glioma and determine its feasibility, by seeking information on glioma imaging practices from the European Neuroradiology community.

Methods: Invitations to a structured survey were emailed to ESNR members (n=1,662) and associates (n=6,400), European national radiologists' societies and distributed via social media.

Results: Responses were received from 220 institutions (59% academic). Conventional imaging protocols generally include T2w, T2-FLAIR, DWI, and pre- and post-contrast T1w. Perfusion MRI is used widely (85.5%), while spectroscopy seems reserved for specific indications. Reasons for omitting advanced imaging modalities include lack of facility/software, time constraints and no requests. Early postoperative MRI is routinely carried out by 74% within 24-72 h, but only 17% report a percent measure of resection. For follow-up, most sites (60%) issue qualitative reports, while 27% report an assessment according to the RANO criteria. A minority of sites use a reporting template (23%).

Conclusion: Clinical best practice recommendations for glioma imaging assessment are proposed and the current role of advanced MRI modalities in routine use is addressed.

Key points: • We recommend the EORTC-NBTS protocol as the clinical standard glioma protocol. • Perfusion MRI is recommended for diagnosis and follow-up of glioma. • Use of advanced imaging could be promoted with increased education activities. • Most response assessment is currently performed qualitatively. • Reporting templates are not widely used, and could facilitate standardisation.

Keywords: Brain neoplasms; Glioma; Guideline; Magnetic resonance imaging; Surveys and questionnaires.

PubMed Disclaimer

Conflict of interest statement

Guarantor

The scientific guarantor of this publication is M. Smits, MD PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because no human subjects/patients were included in this study.

Ethical approval

Institutional Review Board approval was not required because no human subjects/patients were included in this study.

Methodology

• Survey and literature review.

Figures

Fig. 1
Fig. 1
Institutional responses (%) per country. Countries with no responses are shaded grey
Fig. 2
Fig. 2
Percentage of MRI protocols of < 30 min duration for each country. The remaining protocols nearly always lasted between 31 and 60 min. Amongst all 220 responses, only 2.7 % of glioma MRI protocols were longer than 60 min
Fig. 3
Fig. 3
Three possible options for a glioma imaging protocol in clinical practice based on the EORTC-NBTS protocol (a), with the addition of DSC perfusion imaging (b, c). Option C has the advantage over option B that it has double the contrast dose for post-contrast T1w imaging. Option B may be preferred if non-contrast enhanced T2-FLAIR is desired. Please see Ellingson et al. [9] for further considerations and vendor-specific sequence details on structural and diffusion-weighted imaging. The moment of contrast administration is indicated in bold
See this image and copyright information in PMC

References

    1. Ostrom QT, Bauchet L, Davis FG, et al. The epidemiology of glioma in adults: a “state of the science” review. Neuro Oncol. 2014;16:896–913. doi: 10.1093/neuonc/nou087. - DOI - PMC - PubMed
    1. Wen PY, Cloughesy TF, Ellingson BM, et al. Report of the Jumpstarting Brain Tumor Drug Development Coalition and FDA clinical trials neuroimaging endpoint workshop (January 30, 2014, Bethesda MD) Neuro Oncol. 2014;16:vii36–vii47. doi: 10.1093/neuonc/nou226. - DOI - PMC - PubMed
    1. Patzig M, Burke M, Brückmann H, Fesl G. Comparison of 3D cube FLAIR with 2D FLAIR for multiple sclerosis imaging at 3 Tesla. Rofo. 2014;186:484–488. - PubMed
    1. Perleth M, Jakubowski E, Busse R. What is “best practice” in health care? State of the art and perspectives in improving the effectiveness and efficiency of the European health care systems. Health Policy. 2001;56:235–250. doi: 10.1016/S0168-8510(00)00138-X. - DOI - PubMed
    1. Louis DN, Perry A, Burger P, et al. International Society Of Neuropathology--Haarlem consensus guidelines for nervous system tumor classification and grading. Brain Pathol. 2014;24:429–435. doi: 10.1111/bpa.12171. - DOI - PMC - PubMed

Publication types

MeSH terms