Grant: Project Grant

~ 4,000 low-grade gliomas (LGGs) are diagnosed in North America yearly. LGGs grow slowly over many years and are deadly. There is still a lack of consensus regarding how to treat them effectively. Initial LGG diagnosis is made via a standard MRI and patients are then monitored via routine contrast-based MRIs performed every 6 months. The decision to perform surgery is typically made upon evidence of significant growth. Earlier identification of progression may drastically improve outcomes by allowing clinicians to make a more informed decision as to the timing of the surgery and as to when to employ additional treatments such as chemo- or radiotherapy. Such early identification could be attained through monitoring the metabolic activity of the LGG tumour. If metabolic imaging can confirm that the tumour cells are actively dividing, this would prompt treatment, including the administration of novel therapeutics known as IDH inhibitors that may replace standard therapies. In this project, we propose to test whether: 1. Metabolic imaging can predict changes in LGG prior to standard MRI. 2. Metabolic MRI alone can be used to guide LGG diagnosis and treatment response and replace standard gadolinium MRI for surveillance. We will use metabolic MRI in 100 LGG patients. 50 patients will be followed by the neurosurgeon deciding based on standard MRI follow-up as to when to operate. A second cohort of 50 patients who have already undergone surgery and have been confirmed to have LGG, will be followed by the oncologist who will decide based on standard MRI when to initiate chemotherapy and/or radiotherapy. All patients will also undergo metabolic MRI scans every 4 months, as part of their routine observation schedule. We hypothesize that metabolic MRI will be capable of predicting the tumour growth both before and after surgery and earlier than standard MRI. This will provide critical information on the utility of metabolic MRI methods for a future intervention based study.