Advances in Imaging Modalities for Pediatric Brain and Spinal Cord Tumors

Background: Neuroimaging has evolved from anatomical imaging towards a multi-modality comprehensive anatomical and functional imaging in the past decades, important functional data like perfusion weighted imaging, permeability imaging, diffusion weighted and diffusion tensor imaging (DWI, DTI), tractography, metabolic imaging, connectomics, event related functional imaging, resting state functional imaging, and much more is now being offered. Summary: Precision diagnostics has proven to be essential for precision treatment. Many minimal invasive techniques have been developed taking advantage of digital subtraction angiography and interventional neuroradiology. Furthermore, intraoperative CT and/or MRI and more recently MR guided focused ultrasound have complemented the diagnostic and therapeutic armamentarium. Key Messages: In the current manuscript we discuss standard imaging sequences including advanced techniques like DWI, DTI, susceptibility weighted imaging (SWI) and 1H magnetic resonance spectroscopy (MRS), various perfusion weighted imaging approaches including arterial spin labeling (ASL), dynamic contrast enhanced (DCE) imaging and dynamic susceptibility contrast (DSC) imaging. Pre-, intra and postoperative surgical imaging including visualize imaging will be discussed. The value of connectomics will be presented for its value in neuro-oncology. Minimal invasive therapeutic possibilities of interventional neuroradiology and image guided laser ablation and MR guided high intensity focused ultrasound will be presented for treatment of pediatric brain and spinal cord tumors. Finally, a comprehensive review of spinal cord tumors and matching neuropathology has been included.