Advanced imaging of gliomas

Gliomas are the most common in primary malignant Central Nervous System tumors arising from glial cells in a global scenario where breast cancer is the highest-incidence cancer. They represent a very heterogeneous group but astrocytomas have the biggest incidence among all. Taking in account the newest standards in treatment, determining molecular and histopathological patterns is actually considered imperative to get the best management for pathology and its best outcome. Imaging plays a key role in all the steps of the diagnostic pathway, from diagnosis to treatment and in follow-up, also being essential in defining prognosis. Conventional gadolinium-enhanced Magnetic Resonance and particularly its new Advanced techniques (diffusion, perfusion, spectroscopy), definitely have been recognized to represent leading. Imaging modalities in both of initial patients’ work-up and in follow-up, also if some limitation is present, such as a not completely and satisfying discrimination between high and low grade gliomas and/or between disease recurrences and physiological post-therapy changes and in fact MRI is today the most sensitive and accurate method of imaging in many fields of diagnostics. Other novel hybrid Imaging modalities (PET/MRI) were found to be very interesting during patients follow-up, thanks to their high sensitivity and specificity in detecting any kind of post-treatment tissue change and also in evaluating prognosis. Aim of this work is to highlight all the leading Imaging modalities that actually give the best chances in diagnostic pathways of gliomas, pointing out potentialities and limitations of any technique, also in the light of new frontiers that Artificial Intelligence offers.