Mukherji SK, consulting ed. Sundgren PC, guest ed. Advanced Imaging Techniques in Brain Tumors. Elsevier; November 2009. Neuroimaging Clinics of North America; vol. 19, no. 4, pgs. 517-700, $99.
Improvements in imaging technology have allowed for a shift in the approach to the radiological investigation of brain tumors from a strictly morphologic assessment to a more functional and physiological one. This issue of the Neuroimaging Clinics of North America is a well written and comprehensive book that covers several new MR physiologic-based methods and recent advances in PET molecular imaging that have the potential to improve tumor characterization, provide critical information on tumor biology, and facilitate therapeutic decisions and monitor prognosis.
There are 10 chapters, and each chapter is authored by different authorities in neuroradiology, neurology, radiation oncology, neurosurgery, and the field of neurooncological research. The chapters are well organized and basically cover an imaging section on advanced MR imaging techniques that include perfusion, diffusion, sodium imaging, fMRI, tractography, and PET molecular imaging, as well as a section on newer therapeutic strategies.
The chapter on MR perfusion imaging is particularly exciting and covers extensively the pathophysiology of brain tumor perfusion and vascular permeability, the different available imaging techniques with their pitfalls and limitations, and the clinical applications. Preliminary studies with dynamic perfusion imaging show that it is a surrogate market for angiogenesis and has been used to assess brain tumor treatment response with high sensitivity for distinguishing residual/recurrent neoplasm from radiation brain injury and possibly differentiate pseudoprogression from true tumor progression. Further research studies and clinical trials are necessary to refine the data of perfusion metrics for predicting glioma grade and outcome and assessing therapeutic efficacy to novel antiangiogenic agents.
The next chapter is equally informative and discusses the clinical utility of diffusion imaging as a biomarker of treatment response. Sodium MR imaging provides insight of this novel technique for assessment of tissue viability in the setting of brain tumors. Preliminary studies have shown this tool to be an effective method for monitoring early tumor response to radiation therapy.
The chapter on presurgical treatment planning emphasizes the importance that the neurosurgeons place on fMRI and diffusion tractography for intraoperative image guidance. Readers get an extensive overview of mapping of the language network (as justified by the title of the topic), but a discussion on the sensorimotor cortex activation would have certainly been useful.
The chapter on therapeutic advances takes the reader through the standard of care of malignant gliomas, current concepts of targeted agents in recurrent disease, and the controversial role of antiangiogenic agents and their biologic effects, to name a few.
The book ends with a beautifully illustrated chapter that provides a systematic approach to the clinicopathological diagnosis of the commonly encountered central and lateral skull base lesions based on anatomic localization and imaging features. It focuses on the importance of cross- sectional imaging on the presurgical approach, treatment planning, and follow up of patients with skull base lesions.
Overall there are very few weaknesses in this book, and with the exception of the relative paucity and poor quality of the fMR and DTI color maps on the chapter on presurgical language mapping; the issue accomplishes its goal of providing a comprehensive overview of the newest multimodality imaging methods and novel strategies for treatment of malignant gliomas. It is a useful addition to the long line of Neuroimaging Clinics of North America and a valuable resource for all those interested in learning more about the latest classification, current concepts in diagnosis, and management of brain tumors.
