title: Advanced MR imaging in hemispheric low-grade gliomas before surgery; the indications and limits in the pediatric age.
abstract: BACKGROUND
  Advanced magnetic resonance imaging (MRI) techniques is an umbrella term that includes diffusion (DWI) and diffusion tensor (DTI), perfusion (PWI), spectroscopy (MRS), and functional (fMRI) imaging. These advanced modalities have improved the imaging of brain tumors and provided valuable additional information for treatment planning. Despite abundant literature on advanced MRI techniques in adult brain tumors, few reports exist for pediatric brain ones, potentially because of technical challenges.
  
  
  METHODS
  The authors review techniques and clinical applications of DWI, PWI, MRS, and fMRI, in the setting of pediatric hemispheric low-grade gliomas.
  
  
  METHODS
  The authors propose their personal experience to highlight benefits and limits of advanced MR imaging in diagnosis, grading, and presurgical planning of pediatric hemispheric low-grade gliomas.
  
  
  CONCLUSIONS
  Advanced techniques should be used as complementary tools to conventional MRI, and in theory, the combined use of the three techniques should ensure achieving the best results in the diagnosis of hemispheric low-grade glioma and in presurgical planning to maximize tumor resection and preserve brain function.
  
  
  CONCLUSIONS
  In the setting of pediatric neurooncology, these techniques can be used to distinguish low-grade from high-grade tumor. However, these methods have to be applied on a large scale to understand their real potential and clinical relapse, and further technical development is required to reduce the excessive scan times and other technical limitations.
authors.affiliation: Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy. simona.gaudino@gmail.com.
authors.forename: Simona
authors.identifier: http://orcid.org/0000-0003-1681-4343
authors.initials: S
authors.lastname: Gaudino
authors.affiliation: Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy.
authors.forename: Rosellina
authors.initials: R
authors.lastname: Russo
authors.affiliation: Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Verdolotti
authors.affiliation: Department of Neuroscience, Imaging and Clinical Science, University "G. D'annunzio", Chieti, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Caulo
authors.affiliation: Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Colosimo
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D057234:Preoperative Period
keywords: Brain; Functional imaging; Glioma; MR perfusion; MR spectroscopy; Pediatric