Target Volume Determination 2015

Grading in gliomas

Diagnosis please...

Glioblastoma

Grade II glioma

Cho

Grade III / IV glioma

Cr

NAA

Cho

Cho

NAA

Lipids

Grading

FLAIR

CE T1

Cho / Cr

NAA

Cr

Cho

NAA

NAA

Cr

Cr

Cho

ppm

4.0 3.0 2.0 1.0 3.5 2.5 1.5 0.5 ppm

4.0 3.0 2.0 1.0 3.5 2.5 1.5 0.5 ppm

4.0 3.0 2.0 1.0 3.5 2.5 1.5 0.5

Metastasis

FLAIR

CE T1

Cho / Cr

c/oH.-P.Schlemmer,Heidelberg /Tübingen

Gold standard?

Tumor hetereogeneity

• Grade determined by highest malignant component • Any biopsy subject to sampling error

Radiation injury

DSC Perfusion

FLAIR

1H-MRS (Choline/NAA)