Novel approaches to imaging brain tumors

The rapid development of brain imaging has had a dramatic impact on the dia gnosis and treatment of brain tumors. Tumors are detected earlier and with greater certainty. In addition to enhancing substantially the effectiveness of traditional approaches for establishing diagnosis and treatment, modern imaging methods have allowed development of many noninvasive or minimally invasive neurosurgical strategies. The prognosis for an unacceptably large proportion of patients with brain tumors remains poor, however, and substan tial clinical challenges remain. The primary problem in brain tumor treatment is to develop strategies for e ffective elimination of tumor cells without unacceptable damage to healthy tissue. Because tumors and their hosts are heterogeneous, there are many cr ucial secondary problems related to the individualization of therapy. It st ill is not possible in general to define precise histology and to establish prognosis entirely noninvasively or to assess responses to therapy rapidly . After initial treatment, methods for early discrimination of tumor recurr ence from post-treatment changes are insensitive. These all are areas in which neuroimaging applications have developed or ar e promising. This article provides a brief overview of some of the newer im aging technologies that likely could benefit neuro-oncology. Several strate gies are identified selectively for potentially improving the clinical care of patients with brain tumors using imaging methods to facilitate the foll owing: 1. Early detection of tumors or their recurrence 2. Noninvasive diagnosis and classification 3. Treatment First, current practices in brain tumor management are reviewed. The major imaging technologies currently in use are outlined.