MRI plays a key role in the evaluation of post-treatment changes, both in the immediate post-operative period and during follow-up. There are many different treatment’s lines and many different neuroradiological findings according to the treatment chosen and the clinical timepoint at which MRI is performed. Structural MRI is often insufficient to correctly interpret and define treatment-related changes. For that, advanced MRI modalities, including perfusion and permeability imaging, diffusion tensor imaging, and magnetic resonance spectroscopy, are increasingly utilized in clinical practice to characterize treatment effects more comprehensively. This article aims to provide an overview of the role of advanced MRI modalities in the evaluation of treated glioblastomas. For a didactic purpose, we choose to divide the treatment history in three main timepoints: post-surgery, during Stupp (first-line treatment) and at recurrence (second-line treatment). For each, a brief introduction, a temporal subdivision (when useful) or a specific drug-related paragraph were provided. Finally, the current trends and application of radiomics and artificial intelligence (AI) in the evaluation of treated GB have been outlined.

Background: The multi-disciplinary tumor board (MTB) is essential to quality cancer care and currently recommended to offer the best personalized clinical approach, but little has been published regarding MTBs in neuro-oncology (nMTBs). The aim of the present paper is to describe our nMTB, to evaluate its impact on clinical management decisions, and to assess the role of neuroradiologists. Methods: The retrospective evaluation of the cases discussed at our nMTB from March 2017 to March 2020. From the electronic records, we extracted epidemiological, clinical and other specific data of nMTB. From the radiological records, we calculated data relating to the number, time for revision, and other specifications of MRI re-evaluation. Statistical analysis was performed. Results: a total of 447 discussions were analyzed, representing 342 patients. The requests for case evaluations came from radiation oncologists (58.8%) and neurosurgeons (40.5%), and were mainly addressed to the neuroradiologist (73.8%). The most frequent questions were about the treatment’s changes (64.4%). The change in patient treatment was reported in 40.5% of cases, 76.8% of these were based on the neuroradiologic assessment. A total of 1514 MRI examinations were re-evaluated, employing approximately 67 h overall. The median of the MRI exams reviewed per patient was 3 (min–max 1–12). Conclusions: Our study supported that the multidisciplinary approach to patient care can be particularly effective in managing brain tumors. A review by an expert neuroradiologist impacts patient management in the context of nMTBs, but has costs in terms of the time and effort spent preparing for it.

Craniopharyngiomas continue to present a challenge in clinical practice due to their heterogeneity and unpredictable adherence to vital neurovascular structures, particularly the hypothalamus. This results in different degrees of hypothalamus–pituitary axis dysfunction and a lack of uniform consensus and treatment guidelines regarding optimal management. MRI and CT are complementary techniques in the preoperative diagnostic phase, enabling the precise definition of craniopharyngioma size, shape, and consistency, as well as guiding classification into histopathological subtypes and topographical categories. Meanwhile, MRI plays a crucial role in the immediate postoperative period and follow-up stages by identifying treatment-related changes and residual tumors. This pictorial essay aims to provide an overview of the role of imaging in identifying variables indicative of the adherence degree to the hypothalamus, hypothalamic–pituitary dysfunction, the extent of surgical excision, and prognosis. For a more comprehensive assessment, we choose to distinguish the following two scenarios: (1) the initial diagnosis phase, where we primarily discuss the role of radiological variables predictive of adhesions to the surrounding neurovascular structures and axis dysfunction which may influence the choice of surgical resection; (2) the early post-treatment follow-up phase, where we discuss the interpretation of treatment-related changes that impact outcomes.

Background/Objectives: In patients with intracranial arteriovenous malformation (AVM), the first diagnostic analysis is often performed in emergency conditions by Computed Tomography (CT) and multiphase CT angiography (CTA). Nevertheless, once ruptured, an AVM might be hardly recognized by an inexperienced neuroradiologist, due to the presence of hematoma or to the destructuring of the lesion. The aim of our study is to outline the utility of color-coded maps derived from multiphase CT angiography in the assessment of cerebral AVMs, evaluating inter-observer agreement between radiologists with different years’ experience and comparing the results with the gold standard, angiography. Methods: The color-coded maps were obtained retrospectively by multiphase CT angiography on a workstation using FastStroke software ColorViz (GE Healthcare, Milwaukee, WI, USA). The color-coded maps were evaluated, independently, by two neuroradiologists, and inter-observer agreement was evaluated. Finally, the AVM’s features (arterial feeders, nidus type, venous drainage type) obtained with color-coded maps were compared with angiographic analysis. The Ethical Committee for Research in Medical Imaging approved this study (Institutional Review Board number 6467). Informed consent was obtained for every patient. Results: A total of 26 patients with intracranial hemorrhage and arteriovenous malformation underwent multiphase CT angiography and were analyzed. Our statistical analysis showed the reproducibility of the color-coded maps and agreement with the angiographic findings, especially in the evaluation of venous drainage type. Conclusions: The ColorViz color-coded maps have proved to be an effective tool in the identification and assessment of AVMs, providing rapid and clear information on intracranial vascular dynamics, even for inexperienced radiologists.