title: New pathology classification, imagery techniques and prospective trials for meningiomas: the future looks bright.
abstract: OBJECTIVE
  Advances in functional and metabolic imaging have been added to the diagnostic armamentarium for meningioma. New prospective trials have been initiated, and it is foreseen that American Society of Clinical Oncology evidence-level II will be soon available for this brain tumor. This review will focus on recent advances in radiology and their significance for clinical care. The new WHO classification will be detailed.
  
  
  RESULTS
  Brain invasion is an important criterion in the 2007 WHO classification for atypical meningioma. Apparent diffusion coefficient values on MRI observed with grade II and grade III meningiomas are significantly decreased when compared to benign tumors. [F]fluorodeoxyglucose PET may also predict tumor grade and tumor recurrence. Radio-labeled amino acid PET may be used to delineate target volume for radiotherapy planning. Stereotactic biopsy guidance and functional therapy monitoring could be foreseen using PET-MRI. One phase II study is assessing the benefit of dose escalation for nonbenign meningioma and another evaluates the therapeutic strategy of observation, standard- and high-dose radiotherapy for low-risk, intermediate-risk and high-risk patients.
  
  
  CONCLUSIONS
  The use of functional MRI, with or without PET imaging, may be useful in assessing the potential clinical outcome of meningioma. Various therapeutic strategies, including observation and high-dose radiotherapy, are evaluated in two ongoing phase II studies.
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital and University of Geneva, Geneva, Switzerland. damien.weber@unige.ch
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
authors.forename: Karl-Olof
authors.initials: KO
authors.lastname: Lovblad
authors.forename: Leland
authors.initials: L
authors.lastname: Rogers
mesh_terms: D024221:Antineoplastic Protocols / Q000592:standards; D003952:Diagnostic Imaging / Q000379:methods / Q000639:trends*; D005544:Forecasting; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000639:trends; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000532:radiotherapy*; D008579:Meningioma / Q000175:diagnosis / Q000473:pathology* / Q000532:radiotherapy*; D049268:Positron-Emission Tomography / Q000379:methods / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000639:trends