title: Non-invasive metabolic imaging of brain tumours in the era of precision medicine.
abstract: The revolution in cancer genomics has uncovered a variety of clinically relevant mutations in primary brain tumours, creating an urgent need to develop non-invasive imaging biomarkers to assess and integrate this genetic information into the clinical management of patients. Metabolic reprogramming is a central hallmark of cancer, including brain tumours; indeed, many of the molecular pathways implicated in the pathogenesis of brain tumours result in reprogramming of metabolism. This relationship provides the opportunity to devise in vivo metabolic imaging modalities to improve diagnosis, patient stratification, and monitoring of treatment response. Metabolic phenomena, such as the Warburg effect and altered mitochondrial metabolism, can be leveraged to image brain tumours using techniques including PET and MRI. Moreover, genetic alterations, such as mutations affecting isocitrate dehydrogenase, are associated with unique metabolic signatures that can be detected using magnetic resonance spectroscopy. The need to translate our understanding of the molecular features of brain tumours into imaging modalities with clinical utility is growing; metabolic imaging provides a unique platform to achieve this objective. In this Review, we examine the molecular basis for metabolic reprogramming in brain tumours, and examine current non-invasive metabolic imaging strategies that can be used to interrogate these molecular characteristics with the ultimate goal of guiding and improving patient care.
authors.affiliation: Department of Radiation Oncology, University of Michigan Health System, University of Michigan.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Kim
authors.affiliation: Department of Pathology, University of Michigan Health System, University of Michigan, 3520E Medical Science Research Building 1, 1150 West Medical Center Drive, Ann Arbor, Michigan 48104, USA.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Parolia
authors.affiliation: Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Dunphy
authors.affiliation: Department of Pathology, University of Michigan Health System, University of Michigan, 3520E Medical Science Research Building 1, 1150 West Medical Center Drive, Ann Arbor, Michigan 48104, USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Venneti
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D015687:Cell Hypoxia / Q000502:physiology; D049109:Cell Proliferation / Q000502:physiology; D002648:Child; D002952:Citric Acid Cycle / Q000235:genetics; D018450:Disease Progression; D005227:Fatty Acids / Q000378:metabolism; D015894:Genome, Human; D005910:Glioma / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D009154:Mutation / Q000235:genetics; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism; D059906:Neuroimaging / Q000379:methods*; D009857:Oncogenes / Q000235:genetics; D049268:Positron-Emission Tomography / Q000379:methods; D057285:Precision Medicine / Q000379:methods*; D011379:Prognosis; D015398:Signal Transduction / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000596:Amino Acids; D014408:Biomarkers, Tumor; D005227:Fatty Acids