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Todate,multipleadvancedmagneticresonanceimaging(MRI)methodsbeyondconventionalqualitativestructuralimagingforthediagnosis,prognosis,andtreatmentfollow-upofgliomahavedemonstratedtheirutilityforclinicalstudies.However,thesemethodsoftenrelyoncomplexoff-scannerprocessingtoyieldthemostinformationandtoextractquantitativebiomarkers,limitingtheirpracticaluseforstudies,aswellastheirclinicaltranslation.Whilecommunity-drivensoftwaresolutionsexistfortheseadvancedMRImethods,manyaspiringclinicalresearchersfacechallengesinacquiringthenecessaryknowledgetoeffectivelyapplythesetools.Thisguide,aninitiativeoftheGliomaMRimaging2.0network(GliMR),aimstoprovideanoverviewofexistingsolutions,communities,andrepositorieswiththeultimategoalofenablingstandardization,openscience,andreproduciblequantitativeimagingstudiesofgliomas.Yet,mostofthereviewedtoolsandapproachestoimagedataanalysesmayalsobeusedinthecontextofstudiesondiseasesotherthanglioma.

Todate,multipleadvancedmagneticresonanceimaging(MRI)methodsbeyondconventionalqualitativestructuralimagingforthediagnosis,prognosis,andtreatmentfollow-upofgliomahavedemonstratedtheirutilityforclinicalstudies.However,thesemethodsoftenrelyoncomplexoff-scannerprocessingtoyieldthemostinformationandtoextractquantitativebiomarkers,limitingtheirpracticaluseforstudies,aswellastheirclinicaltranslation.Whilecommunity-drivensoftwaresolutionsexistfortheseadvancedMRImethods,manyaspiringclinicalresearchersfacechallengesinacquiringthenecessaryknowledgetoeffectivelyapplythesetools.Thisguide,aninitiativeoftheGliomaMRimaging2.0network(GliMR),aimstoprovideanoverviewofexistingsolutions,communities,andrepositorieswiththeultimategoalofenablingstandardization,openscience,andreproduciblequantitativeimagingstudiesofgliomas.Yet,mostofthereviewedtoolsandapproachestoimagedataanalysesmayalsobeusedinthecontextofstudiesondiseasesotherthanglioma.

Preoperative clinical MRI protocols for gliomas, brain tumors with dismal outcomes due to their infiltrative properties, still rely on conventional structural MRI, which does not deliver information on tumor genotype and is limited in the delineation of diffuse gliomas. The GliMR COST action wants to raise awareness about the state of the art of advanced MRI techniques in gliomas and their possible clinical translation. This review describes current methods, limits, and applications of advanced MRI for the preoperative assessment of glioma, summarizing the level of clinical validation of different techniques. In this second part, we review magnetic resonance spectroscopy (MRS), chemical exchange saturation transfer (CEST), susceptibility-weighted imaging (SWI), MRI-PET, MR elastography (MRE), and MR-based radiomics applications. The first part of this review addresses dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) MRI, arterial spin labeling (ASL), diffusion-weighted MRI, vessel imaging, and magnetic resonance fingerprinting (MRF).

Preoperative clinical MRI protocols for gliomas, brain tumors with dismal outcomes due to their infiltrative properties, still rely on conventional structural MRI, which does not deliver information on tumor genotype and is limited in the delineation of diffuse gliomas. The GliMR COST action wants to raise awareness about the state of the art of advanced MRI techniques in gliomas and their possible clinical translation or lack thereof. This review describes current methods, limits, and applications of advanced MRI for the preoperative assessment of glioma, summarizing the level of clinical validation of different techniques. In this first part, we discuss dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) MRI, arterial spin labeling (ASL), diffusion-weighted MRI, vessel imaging, and magnetic resonance fingerprinting (MRF). The second part of this review addresses magnetic resonance spectroscopy (MRS), chemical exchange saturation transfer (CEST), susceptibility-weighted imaging (SWI), MRI-PET, MR elastography (MRE), and MR-based radiomics applications.

MRS, including single-voxel spectroscopy and MR spectroscopic imaging, captures metabolites in high-grade gliomas. Emerging evidence indicates that 7T MRS may be more sensitive to aberrant metabolic activity than lower-field strength MRS. However, the literature on the use of 7T MRS to visualize high-grade gliomas has not been summarized. We aimed to identify metabolic information provided by 7T MRS, optimal spectroscopic sequences, and areas for improvement in and new applications for 7T MRS. Literature was found on PubMed using "high-grade glioma," "malignant glioma," "glioblastoma," "anaplastic astrocytoma," "7T," "MR spectroscopy," and "MR spectroscopic imaging." 7T MRS offers higher SNR, modestly improved spatial resolution, and better resolution of overlapping resonances. 7T MRS also yields reduced Cramér-Rao lower bound values. These features help to quantify D-2-hydroxyglutarate in isocitrate dehydrogenase 1 and 2 gliomas and to isolate variable glutamate, increased glutamine, and increased glycine with higher sensitivity and specificity. 7T MRS may better characterize tumor infiltration and treatment effect in high-grade gliomas, though further study is necessary. 7T MRS will benefit from increased sample size; reductions in field inhomogeneity, specific absorption rate, and acquisition time; and advanced editing techniques. These findings suggest that 7T MRS may advance understanding of high-grade glioma metabolism, with reduced Cramér-Rao lower bound values and better measurement of smaller metabolite signals. Nevertheless, 7T is not widely used clinically, and technical improvements are necessary. 7T MRS isolates metabolites that may be valuable therapeutic targets in high-grade gliomas, potentially resulting in wider ranging neuro-oncologic applications.