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Advances in Imaging Techniques for Disease Monitoring of High Grade Gliomas during Immunotherapy

Timothy Kim, Dimitrios Mathios, Siddhartha Srivastava, Michael Lim*

In general, high grade gliomas have a dismal prognosis. However, recent advances in disease classification, surgical treatment, and adjuvant therapy have increased the overall survival of this patient population. While a significant number of resources is used to improve treatment for high grade gliomas, there are few advancements in technology development towards an accurate non-invasive assessment of response to these therapeutic modalities. The advent of new treatment modalities and especially the increasing number of immunotherapy clinical trials for high grade gliomas necessitate the development of new approaches for accurate and timely assessment of treatment response in brain tumors. Conventional MRI assessment of response to immunotherapy is inadequate to guide treatment leading to a high number of surgical procedures for definitive assessment. In this review, we are outlining the evolution of imaging criteria as well as the advancements in imaging technology and computational analysis to address the challenges of disease monitoring in the setting of immunotherapy for high grade gliomas. We give particular emphasis on radiomics, a new field on image analysis that algorithmically assesses a large number of imaging features for an accurate diagnosis.