Imaging for suspected meningioma/glioma
- standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) should be offered as the initial diagnostic test for suspected glioma, unless MRI is contraindicated
- refer people with a suspected glioma to a specialist multidisciplinary team at first radiological diagnosis for management of their tumour
- advanced MRI techniques, such as MR perfusion and MR spectroscopy, should be considered to assess the potential of a high-grade transformation in a tumour appearing to be low grade on standard structural MRI
- consider CT imaging for meningioma (if not already performed) to assess bone involvement if this is suspected.
Use of molecular markers to determine prognosis or guide treatment for glioma
Report all glioma specimens according to the latest version of theWorld Health Organization (WHO) classification. As well as histopathological assessment, include molecular markers such as:
- IDH1 and IDH2 mutations
- ATRX mutations to identify IDH mutant astrocytomas and glioblastomas
- 1p/19q codeletion to identify oligodendrogliomas
- histone H3.3 K27M mutations in midline gliomas
- BRAF fusion and gene mutation to identify pilocytic astrocytoma
Test all high-grade glioma specimens for MGMT promoter methylation to inform prognosis and guide treatment.
Consider testing IDH-wildtype glioma specimens for TERT promoter mutations to inform prognosis
Notes:
- chest X -ray } helps establish whether a primary tumour
- ESR/CRP } or metastasis
- skull X -ray - look for signs of raised intracranial pressure, e.g. suture separation; calcification, e.g. hyperostosis of adjacent bone in meningioma; erosion of posterior clinoids, e.g. craniopharyngioma; osteolytic lesions, e.g. dermoid, epidermoid, meningiomas
- angiography - may help differentiate certain tumours, e.g. meningiomas, secondary tumours and gliomas; also used to exclude arteriovenous malformations / aneurysms biopsy
- burr hole, stereotactic, open with decompression
- other tumour markers - alpha-fetoprotein and human chorionic gonadotrophin are reliable markers for germinomas
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