Dr. Edmond Alan Knopp, MD

Of the approximately 35,000 Americans diagnosed with primary brain cancer this year, all ~16,000 with high-grade (WHO class III - IV) gliomas will succumb to their disease within 2 years if treated and in less than 6 months if untreated. This dire prognosis improved little for over 30 years, despite continual advances in diagnosis and treatment, which classically starts with surgical resection (when possible) with resultant pathologic diagnosis. This is followed by either up-front chemotherapy, or conformal radiation therapy followed by high-dose chemotherapy. Unfortunately, it is likely that the extensive invasive characteristic of these tumors in all essence, precludes complete surgical resection, which may, in part, explain their ultimate fatal recurrence. Presented with a large lesion comprising region(s) of signal abnormality with enhancing foci surrounded by normal-appearing white matter (NAWM), the neuroradiologist and oncologist face three key questions: (a) Is just the …enhancing area high grade? (b) How much surrounding non-enhancing area is also high grade? (c) How much distal NAWM is infiltrated? The answers are of practical prognostic importance and the basis for treatment decision making, i.e., radical versus conservative surgical resection, up front chemotherapy and/or avoidance of irradiation. Therefore, closer determination of the true extent of a neoplasm would have considerable impact establishing more reliable prognosis and therapy strategy. Through the use of an armamentarium of advanced MRI methods, including perfusion imaging, spectroscopic imaging, diffusion methods and quantitative whole brain spectroscopy we hope to gain an insight into the true extend of these neoplasms and thereby impact therapy and outcome.