investigation of glioma

Last edited 11/2018 and last reviewed 07/2023

Investigation of suspected glioma Imaging for suspected 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.

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.

Testing IDH-wildtype glioma specimens for TERT promoter mutations should be considered to inform prognosis

Reference:

• NICE (July 20180. Brain tumours (primary) and brain metastases in adults