Acta Neurochirurgica (2025) 167:174
Advanced MRI techniques—including perfusion, diffusion, spectroscopy, and functional imaging—are critical in glioma diagnosis, surgical planning, and treatment monitoring. These modalities improve tumor characterization, guide safer resections, and help distinguish tumor progression from treatment effects, supporting precision neurosurgical oncology and personalized care.
• High-grade gliomas are aggressive brain tumors with poor prognosis, requiring advanced imaging for diagnosis and management.
• MRI is central throughout the patient journey, from initial detection and differential diagnosis to surgical planning, treatment response, and surveillance.
• Advanced MRI techniques—perfusion, diffusion, spectroscopy, fMRI, and DTI—improve tumor characterization, surgical planning, and assessment of infiltration and eloquent cortex involvement.
• Perfusion MRI (DSC, DCE, ASL) and DWI help distinguish high-grade gliomas from mimics and guide biopsy or surgery.
• MR spectroscopy provides metabolic information, aiding in differentiating gliomas from metastases and guiding surgical margins.
• Postoperative MRI is crucial for assessing residual tumor, complications, and radiotherapy planning.
• MRI during treatment surveillance helps differentiate true progression from pseudoprogression or radiation necrosis.
• Future advances include higher field strengths, molecular imaging, and AI integration for precision neuro-oncology.
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