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Diffusion-weighted MRI in neuro-oncology.

Diffusion-weighted MRI (DW-MRI) provides image contrast dependent on the molecular movement of water. It has been most widely used in the diagnosis of cytotoxic edema secondary to acute cerebral ischemia, but has also proven useful in assessing tumor cellularity and grade, abscess formation, cysts and various forms of white matter disorders. Furthermore, DW-MRI is used to generate maps of subcortical white matter tracts and their relationship to structural brain lesions that may serve for preoperative planning and intraoperative guidance. We provide a comprehensive review of current practical applications of DW-MRI in the diagnosis and treatment of primary brain tumors, metastases and nonmetastatic neurologic complications of cancer. A detailed description of diffusion tensor imaging is beyond the scope of this review. We performed a comprehensive search of the PubMed database of the USA National Library of Medicine with use of various combinations of the following search terms: diffusion-weighted imaging, apparent diffusion coefficient, diffusion tensor imaging, diffusion tensor, brain, tumor, glioblastoma, lymphoma, primary CNS lymphoma, stroke, cancer, abscess, leukoencephalopathy, methotrexate, fluorouracil, capecitabine. We identified original articles and well-documented case reports of DW-MRI applications in patients with primary brain neoplasms, metastases and nonmetastatic neurologic complications that we judged to be of high impact on the field. We largely selected publications from the past 10 years, but did not exclude commonly referenced and highly regarded older publications. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. Review articles are cited to provide readers with more details and more references than can be covered here.