Imaging Approaches and Clinical Decision-Making in DMG Diagnosis

Funding support provided by Chimerix/Jazz Pharmaceuticals. Content independently developed and published by OncLive.

The diagnostic process for gliomas often begins in the emergency department, where patients presenting with neurological symptoms typically undergo a non-contrast CT scan. While this initial imaging helps rule out acute issues, persistent or concerning findings usually lead to a contrast-enhanced MRI for greater clarity. In academic centers, advanced MRI protocols are often employed, including diffusion tensor imaging, MR perfusion, MR permeability, and MR spectroscopy, which provide additional insight into tumor behavior. Functional MRI and fiber tractography may also be incorporated when surgical planning is anticipated, particularly for tumors located near critical brain regions that control language or motor function.

Imaging interpretation is handled by subspecialty-trained neuroradiologists, who communicate results directly to the referring physician. In urgent cases involving herniation, hydrocephalus, or hemorrhage—referred to as the “triple H”—findings are escalated immediately through direct phone calls to emergency providers or neurosurgeons. This rapid communication ensures that life-threatening conditions are addressed before full imaging analysis is completed. For community oncologists, access to advanced imaging modalities and immediate specialty input can be limited, which underscores the importance of partnerships with tertiary centers. Direct communication and timely reporting remain critical in facilitating safe and effective care.

The decision to pursue biopsy versus resection depends largely on imaging features and tumor location. When tumors are deep-seated or involve eloquent regions such as the thalamus or brainstem, biopsy is generally favored to minimize neurological risk. In contrast, more accessible lesions may warrant aggressive surgical resection when potential benefits outweigh risks. Collaboration between neuroradiologists, neurosurgeons, and oncologists plays a central role in determining the safest and most effective approach. These decisions highlight the importance of a multidisciplinary framework, where both urgent management needs and long-term treatment planning are carefully integrated to optimize outcomes for patients with glioma.