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Journal of Immunology Research
Volume 2017, Article ID 5813951, 16 pages
Review Article

MRI in Glioma Immunotherapy: Evidence, Pitfalls, and Perspectives

1Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
2Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
3Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy

Correspondence should be addressed to Maria Grazia Bruzzone; ti.atseb-otutitsi@enozzurb.airam

Received 1 December 2016; Revised 6 February 2017; Accepted 2 March 2017; Published 20 April 2017

Academic Editor: Cristina Maccalli

Copyright © 2017 Domenico Aquino et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Pseudophenomena, that is, imaging alterations due to therapy rather than tumor evolution, have an important impact on the management of glioma patients and the results of clinical trials. RANO (response assessment in neurooncology) criteria, including conventional MRI (cMRI), addressed the issues of pseudoprogression after radiotherapy and concomitant chemotherapy and pseudoresponse during antiangiogenic therapy of glioblastomas (GBM) and other gliomas. The development of cancer immunotherapy forced the identification of further relevant response criteria, summarized by the iRANO working group in 2015. In spite of this, the unequivocal definition of glioma progression by cMRI remains difficult particularly in the setting of immunotherapy approaches provided by checkpoint inhibitors and dendritic cells. Advanced MRI (aMRI) may in principle address this unmet clinical need. Here, we discuss the potential contribution of different aMRI techniques and their indications and pitfalls in relation to biological and imaging features of glioma and immune system interactions.