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Subject: Recent advances in imaging of brain tumors Sanghvi DA - Indian J Cancer
Date: Sat, 9 May 2009 11:05:56 +0200
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}
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}
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BACKGROUND-COLOR: #ffffff
}
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BACKGROUND-COLOR: #ffffff
}
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}
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FONT-FAMILY: Arial, verdana, Helvetica, sans-serif; BACKGROUND-COLOR: =
#eaead7
}
.navCell {
	BORDER-RIGHT: #aac49e 1px solid; BORDER-TOP: #aac49e 1px solid; =
FONT-SIZE: 12px; BORDER-LEFT: #aac49e 1px solid; BORDER-BOTTOM: #aac49e =
1px solid; FONT-FAMILY: Arial, Verdana, Helvetica, sans-serif; =
BACKGROUND-COLOR: #dde8d8
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}
.IssueVolume {
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Helvetica, sans-serif
}
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}
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}
.articleAuthor {
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.CorrsAdd {
	FONT-SIZE: 11px; COLOR: #1f1f3f; LINE-HEIGHT: 125%; FONT-FAMILY: Arial, =
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}
.AuthorAff {
	FONT-SIZE: 11px; COLOR: #1f1f1f; FONT-FAMILY: Arial, Verdana, =
Helvetica, sans-serif
}
.body {
	FONT-SIZE: 9pt; COLOR: #000000; LINE-HEIGHT: 125%; FONT-FAMILY: =
Verdana, Arial, Helvetica, sans-serif
}
.about {
	FONT-SIZE: 9pt; COLOR: #000000; LINE-HEIGHT: 50%; FONT-FAMILY: Verdana, =
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}
.PrePublication {
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FONT-SIZE: 11px; BORDER-LEFT: #eaead7 1px solid; COLOR: #464646; =
BORDER-BOTTOM: #eaead7 1px solid; FONT-FAMILY: Arial, Verdana, =
Helvetica, sans-serif; BACKGROUND-COLOR: #e1e3ed
}
.sitethis {
	BORDER-RIGHT: #eaead1 1px solid; BORDER-TOP: #eaead1 1px solid; =
FONT-SIZE: 11px; BORDER-LEFT: #eaead1 1px solid; LINE-HEIGHT: 135%; =
BORDER-BOTTOM: #eaead1 1px solid; FONT-FAMILY: Arial, Verdana, =
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Helvetica, sans-serif; BACKGROUND-COLOR: #c5c1bd
}
.topBand2MO {
	BORDER-RIGHT: #ffffff 1px solid; BORDER-TOP: #ffffff 1px solid; =
FONT-WEIGHT: bold; FONT-SIZE: 1px; BORDER-LEFT: #ffffff 1px solid; =
COLOR: #ffffff; BORDER-BOTTOM: #ffffff 1px solid; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif; BACKGROUND-COLOR: #9bb4cb
}
.buttonCell {
	BACKGROUND-COLOR: #eaead7
}
.leftnavover {
	BORDER-RIGHT: #ffffff 1px solid; BORDER-TOP: #ffffff 1px solid; =
FONT-WEIGHT: bold; FONT-SIZE: 8pt; BORDER-LEFT: #ffffff 1px solid; =
COLOR: #ffffff; BORDER-BOTTOM: #ffffff 1px solid; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif; BACKGROUND-COLOR: #fcf7e9
}
.sublinkFont {
	FONT-WEIGHT: bold; FONT-SIZE: 8pt; COLOR: #ffffff; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif
}
.topTable {
	FONT-SIZE: 12px; COLOR: #000000; FONT-FAMILY: Arial, Verdana, =
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}
.topBand2 {
	FONT-SIZE: 12px; COLOR: #000000; FONT-FAMILY: Arial, Verdana, =
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}
.rightTopCorner {
	BORDER-RIGHT: #e1c876 1px solid; BORDER-TOP: #e1c876 1px solid; =
FONT-SIZE: 12px; BORDER-LEFT: #e1c876 1px solid; COLOR: #000000; =
BORDER-BOTTOM: #e1c876 1px solid; FONT-FAMILY: Arial, Verdana, =
Helvetica, sans-serif; BACKGROUND-COLOR: #ffffff
}
.Highlight {
	FONT-WEIGHT: bold; FONT-SIZE: 12pt; COLOR: #194d78; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif
}
.HighlightArticleTitle {
	FONT-WEIGHT: bold; FONT-SIZE: 12px; COLOR: #ff6600; FONT-FAMILY: =
verdana ,Arial , Helvetica, sans-serif
}
.toctab {
	PADDING-RIGHT: 5px; BORDER-TOP: #eaead7 5px solid; PADDING-LEFT: 5px; =
FONT-SIZE: 9pt; BORDER-BOTTOM-COLOR: #ffffff; BORDER-LEFT: #f3f0ed 1px =
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}
.tochead {
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}
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}
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.HighlightAbstract {
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}
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FONT-SIZE: 8pt; BORDER-LEFT: #c0c0c0 1px solid; BORDER-BOTTOM: #c0c0c0 =
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}
.searchtable {
	BORDER-RIGHT: #e4e4de 1px solid; PADDING-RIGHT: 5px; BORDER-TOP: =
#e4e4de 6px solid; PADDING-LEFT: 5px; FONT-SIZE: 10pt; BORDER-LEFT: =
#e4e4de 1px solid; LINE-HEIGHT: 125%; BORDER-BOTTOM: #e4e4de 1px solid; =
FONT-FAMILY: Verdana, Arial, Helvetica, sans-serif
}
.articlepage {
	PADDING-RIGHT: 5px; BORDER-TOP: #eaead7 5px solid; PADDING-LEFT: 5px; =
FONT-SIZE: 9pt; BORDER-BOTTOM-COLOR: #ffffff; BORDER-LEFT: #f3f0ed 1px =
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sans-serif; BACKGROUND-COLOR: white; BORDER-RIGHT-COLOR: #ffffff
}
.parameter {
	FONT-SIZE: 12px; COLOR: #113452; FONT-FAMILY: Arial, Verdana, =
Helvetica, sans-serif
}
.parameterhead {
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Verdana, Helvetica, sans-serif
}
.parametertext {
	FONT-WEIGHT: bold; FONT-SIZE: 12px; COLOR: #113452; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif
}
.pageHead {
	FONT-WEIGHT: bold; FONT-SIZE: 16px; COLOR: #113452; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif
}
.other {
	FONT-WEIGHT: normal; FONT-SIZE: 12px; COLOR: #1f1f3f; FONT-FAMILY: =
Arial, Verdana, Helvetica, sans-serif
}
.sTitle {
	FONT-SIZE: 18px; COLOR: #ff6600; LINE-HEIGHT: 110%; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif
}
.ref {
	FONT-SIZE: 11px; COLOR: #cc6601; FONT-FAMILY: Arial, Verdana, =
Helvetica, sans-serif
}
.empty {
	PADDING-RIGHT: 2px; PADDING-LEFT: 2px; FONT-SIZE: 9pt; PADDING-TOP: =
2px; FONT-FAMILY: Verdana, Arial, Helvetica, sans-serif; =
BACKGROUND-COLOR: white
}
.footer {
	COLOR: #ffffff; LINE-HEIGHT: 110%; BACKGROUND-COLOR: #d0dbe5
}
.menu {
	BORDER-RIGHT: #a1a1a1 10px solid; BORDER-TOP: #a1a1a1 10px solid; =
BORDER-LEFT: #a1a1a1 10px solid; BORDER-BOTTOM: #a1a1a1 10px solid
}
.sj {
	FONT-SIZE: 11px; BORDER-BOTTOM-COLOR: #f8c301; BORDER-LEFT: #757373 3px =
solid; COLOR: #333333; BORDER-TOP-COLOR: #f8c301; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif; BACKGROUND-COLOR: #eaead7; =
BORDER-RIGHT-COLOR: #f8c301
}
.menutable {
	BORDER-TOP: #dfd9da 1px solid; BACKGROUND-COLOR: #ffffff
}
.Footertab {
	FONT-SIZE: 10px; COLOR: #000000; FONT-FAMILY: Verdana, Arial, =
Helvetica, sans-serif; BACKGROUND-COLOR: #d9e1e8
}
.foot {
	FONT-SIZE: 10px; COLOR: #000000; FONT-FAMILY: Verdana,  Arial, =
Helvetica, sans-serif
}
.medknow {
	FONT-SIZE: 10px; COLOR: #444444; FONT-FAMILY: Verdana, Arial, =
Helvetica, sans-serif
}
.adlink {
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sans-serif
}
.hban {
	FONT-SIZE: 12px; COLOR: #000000; FONT-FAMILY: Arial, Verdana, =
Helvetica, sans-serif
}
.rtcm {
	BORDER-RIGHT: #ffffff 1px solid; FONT-WEIGHT: bold; FONT-SIZE: 11px; =
COLOR: #ffffff; BORDER-BOTTOM: #a2a2a1 2px solid; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif; BACKGROUND-COLOR: #eaead7
}
.w3c {
	FONT-WEIGHT: bold; FONT-SIZE: 11px; COLOR: #000000; FONT-FAMILY: Arial, =
Verdana, Helvetica, sans-serif
}
.vld {
	FONT-WEIGHT: normal; FONT-SIZE: 10px; COLOR: #000000; FONT-FAMILY: =
Arial, Verdana, Helvetica, sans-serif
}
.ftl {
	CURSOR: hand
}
.bl {
	FONT-WEIGHT: normal; FONT-SIZE: 10px; COLOR: #000000; FONT-FAMILY: =
Arial, Verdana, Helvetica, sans-serif; BACKGROUND-COLOR: #ffffff
}
.spl {
	BORDER-RIGHT: #ffffff 3px dotted; BORDER-TOP: #ffffff 3px dotted; =
FONT-SIZE: 12px; MARGIN-LEFT: 2px; BORDER-LEFT: #ffffff 3px dotted; =
COLOR: #000000; MARGIN-RIGHT: 2px; BORDER-BOTTOM: #ffffff 3px dotted; =
FONT-STYLE: italic; FONT-FAMILY: Arial, verdana Helvetica, sans-serif; =
BACKGROUND-COLOR: #cdd8ba
}
.splnote {
	BORDER-RIGHT: #a6adc4 1px solid; BORDER-TOP: #a6adc4 1px solid; =
FONT-SIZE: 11px; BORDER-LEFT: #a6adc4 1px solid; LINE-HEIGHT: 135%; =
BORDER-BOTTOM: #a6adc4 1px solid; FONT-FAMILY: Arial, Verdana, =
Helvetica, sans-serif; BACKGROUND-COLOR: #e1f3ef
}
.jh {
	BACKGROUND-COLOR: #ffffff
}
.btm {
	BORDER-TOP: #eaead7 1px solid; BACKGROUND: =
url(http://www.indianjcancer.com/images/btm.gif) #eaead7 no-repeat right =
top; COLOR: #555555
}
.ft {
	BACKGROUND: url(http://www.indianjcancer.com/images/ft.gif)
}

------=_NextPart_000_0000_01C9D096.2091D5F0
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://www.indianjcancer.com/templates/layer.js

var link=3Dnew Array()
var delay_hide=3D500
var menuobj;
var menu;
var default_menu_item;



function lib_bwcheck(){ //Browsercheck (needed)
	this.ver=3Dnavigator.appVersion
	this.agent=3Dnavigator.userAgent
	this.dom=3Ddocument.getElementById?1:0
	this.opera5=3Dthis.agent.indexOf("Opera 5")>-1
	this.ie5=3D(this.ver.indexOf("MSIE 5")>-1 && this.dom && =
!this.opera5)?1:0;=20
	this.ie6=3D(this.ver.indexOf("MSIE 6")>-1 && this.dom && =
!this.opera5)?1:0;
	this.ie4=3D(document.all && !this.dom && !this.opera5)?1:0;
	this.ie=3Dthis.ie4||this.ie5||this.ie6
	this.mac=3Dthis.agent.indexOf("Mac")>-1
	this.ns6=3D(this.dom && parseInt(this.ver) >=3D 5) ?1:0;=20
	this.ns4=3D(document.layers && !this.dom)?1:0;
	this.bw=3D(this.ie6 || this.ie5 || this.ie4 || this.ns4 || this.ns6 || =
this.opera5)
	return this
}
var bw=3Dnew lib_bwcheck();

function  x(obj,visible)
{	this.evnt=3Dbw.dom? 	=
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
ers[obj]:0;

	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
   	this.wref=3Dbw.dom||bw.ie4?this.evnt:bw.ns4?this.css.document:0;=09
	this.css.visibility =3D visible;
	this.css.width=3D'100%';

}

function showHideLayer(obj,visible){							=09
   	this.evnt=3Dbw.dom? =
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
ers[obj]:0;

	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
   	this.wref=3Dbw.dom||bw.ie4?this.evnt:bw.ns4?this.css.document:0;=09
	this.css.visibility =3D visible;
	this.css.top=3D'94px';
	bw.ns4||bw.ns6?this.css.left=3D'-8px':
	this.css.left=3D'0px';
	this.css.width=3D'100%';
	this.css.position=3D"absolute";
}


function writeSubmenu(obj,item){							=09
   /*	this.evnt=3Dbw.dom? =
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
ers[obj]:0;
	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
   	this.wref=3Dbw.dom||bw.ie4?this.evnt:bw.ns4?this.css.document:0;=09
	thecontent=3D(item=3D=3D-1)? "" : link[item]
	this.wref.innerHTML=3Dthecontent;*/

}


function clearContent(obj){=09
					=09
   	this.evnt=3Dbw.dom? =
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
ers[obj]:0;
	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
   	this.wref=3Dbw.dom||bw.ie4?this.evnt:bw.ns4?this.css.document:0;=09
	thecontent=3D(item=3D=3D-1)? "" : link[item]
	this.wref.innerHTML=3D"";

}


function clear_delayhide()
{
	alert("asdASD");
	if (window.delayhide)
	{onlpgld(default_menu_item)
	clearTimeout(delayhide)
}
}

function contains_ns6(a, b)=20
{
	while (b.parentNode)
	if ((b =3D b.parentNode) =3D=3D a)
		return true;
	return false;
}



////


function navleftMouseOver(src)
{=20

	src.className=3D"leftnavcellover"
}=20



function navleftMouseOut(src)
{=20
	src.className=3D"leftnavcell"
}

function navtabMouseOver(src)
{=20

		src.className=3D"topBand1MO"
}=20



function navtabMouseOut(src)
{=20
	src.className=3D"topBand2"
}

////



function navMouseOver(src,item)
{=20

	src.className=3D"topBand1MO"
	//writeSubmenu("submenu",item);
	//showHideLayer("submenu","visible");=09
=09

}=20



function navMouseOut(src,lyr)
{=20
	src.className=3D"topBand1";
//	onlpgld(default_menu_item);
=09
}

function onload(item)
{
//	writeSubmenu("submenu",item);
//	showHideLayer("submenu","visible");
	=09
}

function onlpgld(item)
{
	default_menu_item=3Ditem;=09
	writeSubmenu("submenu",item);
	showHideLayer("submenu","visible");

	=09
}

function navMouseOversUB(src)
{=20
	src.className=3D"topBand2MO"

}=20
function navMouseOutsUB(src)
{=20
	src.className=3D"topBand2"
}
function navMouseBotOut(src)
{
	src.className=3D"leftnavcell"
}
function navMouseBotOver(src)
{
	src.className=3D"leftnavcellover"
}

function loadMenu(index)
{
	writeMenu("menu",item);
	showHideLayer("menu","visible");=09
	if (index >=3D 0)
	{
		onload(index)	=09
	}
}


function showMenu(e,f)
{
	var ie4=3Ddocument.all&&navigator.userAgent.indexOf("Opera")=3D=3D-1
	var ns6=3Ddocument.getElementById&&!document.all
	var ns4=3Ddocument.layers
	eventX=3Die4? event.clientX : ns6? e.clientX : e.x
	eventY=3Die4? event.clientY : ns6? e.clientY : e.y
	var rightedge=3Die4? document.body.clientWidth-eventX : =
window.innerWidth-eventX
	var bottomedge=3Die4? document.body.clientHeight-eventY : =
window.innerHeight-eventY

	var obj=3D"floatmenu";
	this.evnt=3Dbw.dom? 	=
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
ers[obj]:0;
	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
   	this.wref=3Dbw.dom||bw.ie4?this.evnt:bw.ns4?this.css.document:0;=09
	this.css.visibility =3D "visible";
	this.css.left=3Die4? document.body.scrollLeft+eventX : ns6? =
window.pageXOffset+eventX : eventX
	 if (bottomedge<this.css.contentheight)
		this.css.top=3Die4? =
document.body.scrollTop+eventY-this.css.contentheight : ns6? =
window.pageYOffset+eventY-this.css.contentheight : =
eventY-this.css.contentheight;
	 else
		 this.css.top=3Die4? document.body.scrollTop+event.clientY : ns6? =
window.pageYOffset+eventY : eventY=20

	this.css.visibility=3D"visible";
	this.css.top=3DeventX;

	alert(eventX);

}


function writeMenu(obj,item)
{
  	this.evnt=3Dbw.dom? =
document.getElementById(obj):bw.ie4?document.all[obj]:bw.ns4?document.lay=
ers[obj]:0;
	if(!this.evnt) return false
	this.css=3Dbw.dom||bw.ie4?this.evnt.style:bw.ns4?this.evnt:0;=09
   	this.wref=3Dbw.dom||bw.ie4?this.evnt:bw.ns4?this.css.document:0;=09
	thecontent=3D(item=3D=3D-1)? "" : menu;
	this.wref.innerHTML=3Dthecontent;

}

function setCSS(typ)
{=20
	var i, a, main;
  for(i=3D0; (a =3D document.getElementsByTagName("link")[i]); i++)=20
	{

	    if(a.getAttribute("rel").indexOf("style") !=3D -1 && 	=
a.getAttribute("title")) {
      	    a.disabled =3D true;
            if(a.getAttribute("title") =3D=3D typ) a.disabled =3D false;
    }
  }
=09
}



function getActiveStyleSheet() {
  var i, a;
  for(i=3D0; (a =3D document.getElementsByTagName("link")[i]); i++) {
    if(a.getAttribute("rel").indexOf("style") !=3D -1 && =
a.getAttribute("title") && !a.disabled) return a.getAttribute("title");
  }
  return null;
}
function openWin(pg)
{

if (pg.indexOf('special') >=3D 0 || pg.indexOf('changeaddress') >=3D 0 )
{
var attributes =3D 'toolbar=3D0,location=3D0,directories=3D0,status=3D0, =
menubar=3D0,scrollbars=3DYes,resizable=3D1,width=3D800,height=3D600,left=3D=
0,top=3D0';
}
else
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Content-Location: http://www.indianjcancer.com/article.asp?issn=0019-509X;year=2009;volume=46;issue=2;spage=82;epage=87;aulast=Sanghvi

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" =
"http://www.w3c.org/TR/1999/REC-html401-19991224/loose.dtd">
<HTML><HEAD><TITLE>Recent advances in imaging of brain tumors Sanghvi DA =
- Indian J Cancer</TITLE>
<META http-equiv=3DContent-Type content=3D"text/html; =
charset=3Dwindows-1252">
<META=20
content=3D"Indian J Cancer, full-text, online, electronic, e-journal, =
free access, open access, online submission"=20
name=3Dkeywords>
<META=20
content=3D"The Indian Journal of Cancer is an official publication of =
the Indian Cancer Society and Indian Society of Oncology."=20
name=3Ddescription><!--DC META DATA START-->
<META content=3D"Recent advances in imaging of brain tumors" =
name=3DDC.Title><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#title" =
rel=3DSCHEMA.dc>
<META content=3DSanghvi name=3DDC.Creator><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#creator" =
rel=3DSCHEMA.dc>
<META=20
content=3D"Diffusion, perfusion, spectroscopy, functional imaging, brain =
tumors"=20
name=3DDC.Subject>
<META=20
content=3D"The recent advances in brain tumor imaging offer unique =
anatomical as well as pathophysiological information that provides new =
insights on brain tumors, directed at facilitating therapeutic decisions =
and providing information regarding prognosis. This information is =
presently utilized in clinical practice for initial diagnosis and =
noninvasive, preoperative grading of tumors, biopsy planning, surgery, =
and radiation portal planning, as well as, prognostication. The newer =
advances described in this review include magnetic resonance (MR) =
diffusion and diffusion tensor imaging with tractography, perfusion =
imaging, MR spectroscopy, and functional imaging, using the blood =
oxygenation level dependent (BOLD) technique.<br>Diffusion tensor MR =
imaging is the only noninvasive <i>in vivo</i> method for mapping white =
matter fiber tract trajectories in the human brain. In the current =
clinical practice, one of the most important indications of diffusion =
tensor imaging (DTI) is to study the relation of a tumor to the adjacent =
white matter tracts. Perfusion imaging with computed tomography (CT) and =
magnetic resonance imaging (MRI) is an exciting new radiological =
technique for noninvasive evaluation of cerebral hemodynamics, in =
certain definite clinical settings. Cerebral perfusion imaging describes =
the passage of blood through the brain's vascular network. Perfusion =
imaging, especially with MRI has become an integral component of the =
complete radiological assessment of brain tumors. MR Spectroscopy (MSR) =
is the only noninvasive technique capable of measuring chemicals within =
the body. MRS distinguishes various metabolites on the basis of their =
slightly different chemical shifts or resonance frequencies. Functional =
MRI refers to the demonstration of brain function with neuroanatomic =
localization on a real-time basis. In patient care, functional MR =
imaging is primarily used in the preoperative evaluation of<i> </i>the =
relationship of a brain tumor with an eloquent cortex.<br>The next =
decade will witness further sophistication of these techniques, with =
data available from larger studies. It is expected that imaging will =
continue to provide new and unique insights in neuro-oncology, which =
should hopefully contribute to the better management of patients with =
brain tumors."=20
name=3DDC.Description><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#description" =
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<META content=3D"Medknow Publications" name=3DDC.Publisher><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#publisher" =
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<META content=3D"Sanghvi DA" name=3DDC.Contributor.PersonalName><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#contributor" =
rel=3DSCHEMA.dc>
<META scheme=3DISO8601 content=3D2009-4-1 name=3DDC.Date><LINK=20
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name=3DDC.Identifier><LINK=20
href=3D"http://purl.org/metadata/dublin_core_elements#identifier" =
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<META content=3D"Indian Journal of Cancer" =
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<META content=3D"Sanghvi DA" name=3Dcitation_authors>
<META content=3D"Recent advances in imaging of brain tumors" =
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<META content=3D46 name=3Dcitation_volume>
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<META content=3D82 name=3Dcitation_firstpage>
<META content=3D10.4103/0019-509X.49145 name=3Dcitation_doi>
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title=3DIntroduction=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
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ction">Introduction</A></TD></TR>
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            title=3D"Diffusion and Diffusion Tensor Imaging"=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#Diffusi=
on and Diffusion Tensor Imaging">Diffusion=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#Perfusi=
on Imaging">Perfusion=20
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nal MRI (F MRI)">Functional=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#Conclus=
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                <TD width=3D"100%" colSpan=3D3><FONT=20
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              <TR>
                <TD width=3D"33%" height=3D5></TD>
                <TD width=3D"33%" height=3D5></TD>
                <TD width=3D"34%" height=3D5></TD></TR>
              <TR>
                <TD class=3Dother width=3D"100%" colSpan=3D3><B>Year =
</B>:=20
                  2009&nbsp; |&nbsp; <B>Volume</B> : 46&nbsp; |&nbsp;=20
                  <B>Issue</B> : 2&nbsp; |&nbsp; <B>Page</B> : =
82-87</TD></TR>
              <TR>
                <TD class=3Dother width=3D"100%"=20
            colSpan=3D3>&nbsp;</TD></TR></TBODY></TABLE>
            <P><FONT class=3DsTitle>Recent advances in imaging of brain=20
            tumors</FONT><BR><BR><FONT class=3DarticleAuthor>DA=20
            Sanghvi</FONT><BR><FONT class=3DAuthorAff>&nbsp;Department =
of=20
            Radiology, KEM Hospital and Seth GS Medical College, Parel,=20
            Mumbai-400 012, Maharashtra, India<BR></FONT><BR></P>
            <P><FONT class=3DCorrsAdd><B>Correspondence =
Address</B>:<BR>D A=20
            Sanghvi<BR>Department of Radiology, KEM Hospital and Seth GS =
Medical=20
            College, Parel, Mumbai-400 012, Maharashtra <BR>India<BR><A=20
            =
href=3D"http://www.indianjcancer.com/login.asp?rd=3Darticle.asp?issn=3D00=
19-509X;year=3D2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3D=
Sanghvi"><IMG=20
            alt=3D"Login to access the Email id"=20
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border=3D0></A>
            <P><B>Source of Support:</B> None, <B>Conflict of =
Interest:</B>=20
            None</P><B>DOI</B>:&nbsp;10.4103/0019-509X.49145<BR></FONT>
            <P></P>
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                <TD class=3DinsideLine width=3D"100%"=20
height=3D1></TD></TR></TBODY></TABLE>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub width=3D"85%" =
height=3D15>&nbsp;=BB<A=20
                  name=3Dabstract></A>&nbsp;Abstract</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD width=3D"15%" height=3D15></TD></TR></TBODY></TABLE>
            <P class=3Dabst>The recent advances in brain tumor imaging =
offer=20
            unique anatomical as well as pathophysiological information =
that=20
            provides new insights on brain tumors, directed at =
facilitating=20
            therapeutic decisions and providing information regarding =
prognosis.=20
            This information is presently utilized in clinical practice =
for=20
            initial diagnosis and noninvasive, preoperative grading of =
tumors,=20
            biopsy planning, surgery, and radiation portal planning, as =
well as,=20
            prognostication. The newer advances described in this review =
include=20
            magnetic resonance (MR) diffusion and diffusion tensor =
imaging with=20
            tractography, perfusion imaging, MR spectroscopy, and =
functional=20
            imaging, using the blood oxygenation level dependent (BOLD)=20
            technique.<BR>Diffusion tensor MR imaging is the only =
noninvasive=20
            <I>in vivo</I> method for mapping white matter fiber tract=20
            trajectories in the human brain. In the current clinical =
practice,=20
            one of the most important indications of diffusion tensor =
imaging=20
            (DTI) is to study the relation of a tumor to the adjacent =
white=20
            matter tracts. Perfusion imaging with computed tomography =
(CT) and=20
            magnetic resonance imaging (MRI) is an exciting new =
radiological=20
            technique for noninvasive evaluation of cerebral =
hemodynamics, in=20
            certain definite clinical settings. Cerebral perfusion =
imaging=20
            describes the passage of blood through the brain's vascular =
network.=20
            Perfusion imaging, especially with MRI has become an =
integral=20
            component of the complete radiological assessment of brain =
tumors.=20
            MR Spectroscopy (MSR) is the only noninvasive technique =
capable of=20
            measuring chemicals within the body. MRS distinguishes =
various=20
            metabolites on the basis of their slightly different =
chemical shifts=20
            or resonance frequencies. Functional MRI refers to the =
demonstration=20
            of brain function with neuroanatomic localization on a =
real-time=20
            basis. In patient care, functional MR imaging is primarily =
used in=20
            the preoperative evaluation of<I> </I>the relationship of a =
brain=20
            tumor with an eloquent cortex.<BR>The next decade will =
witness=20
            further sophistication of these techniques, with data =
available from=20
            larger studies. It is expected that imaging will continue to =
provide=20
            new and unique insights in neuro-oncology, which should =
hopefully=20
            contribute to the better management of patients with brain=20
            tumors.</P><BR>
            <P class=3Dkyds><B>Keywords:</B>&nbsp;Diffusion, perfusion,=20
            spectroscopy, functional imaging, brain tumors</P><BR>
            <TABLE class=3Dsitethis width=3D"100%" border=3D0>
              <TBODY>
              <TR>
                <TD class=3Dother><B>How to cite this =
article:</B><BR>Sanghvi=20
                  DA. Recent advances in imaging of brain tumors. Indian =
J=20
                  Cancer 2009;46:82-7</TD></TR></TBODY></TABLE><BR>
            <TABLE class=3Dsitethis width=3D"100%" border=3D0>
              <TBODY>
              <TR>
                <TD class=3Dother><B>How to cite this =
URL:</B><BR>Sanghvi DA.=20
                  Recent advances in imaging of brain tumors. Indian J =
Cancer=20
                  [serial online] 2009 [cited&nbsp;2009 May 9];46:82-7.=20
                  Available from:&nbsp;<A=20
                  =
href=3D"http://www.indianjcancer.com/text.asp?2009/46/2/82/49145">http://=
www.indianjcancer.com/text.asp?2009/46/2/82/49145</A></TD></TR></TBODY></=
TABLE><BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  =
name=3DIntroduction></A>&nbsp;=BB&nbsp;Introduction</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#top"><I=
MG=20
                  alt=3DTop=20
                  =
src=3D"http://www.indianjcancer.com/images/arrow_top.gif"=20
                  border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>Over =
the past few=20
            decades, as novel therapies for patients with brain tumors =
are being=20
            developed, we are witnessing a shift in imaging from merely=20
            providing anatomical information toward providing =
information about=20
            tumor physiology. The recent advances in brain tumor imaging =
offer=20
            unique anatomical as well as pathophysiological information =
that=20
            provides new insights on brain tumors, directed at =
facilitating=20
            therapeutic decisions and providing information regarding =
the=20
            prognosis. This information is presently utilized in =
clinical=20
            practice for the initial diagnosis and noninvasive, =
preoperative=20
            grading of tumors, biopsy planning, surgery, and radiation =
portal=20
            planning as well as prognostication.In research =
environments, these=20
            tools are utilized by investigators of studies on brain =
tumors in a=20
            variety of study designs with various aims.<BR><BR>The newer =

            advances described in this review include MR diffusion and =
diffusion=20
            tensor imaging with tractography, perfusion imaging, MR=20
            spectroscopy, and functional imaging using the BOLD =
technique.The=20
            physics of each technique is only briefly described with =
greater=20
            emphasis on clinical applications, since the review is aimed =

            primarily at neurosurgeons, neurophysicians, and oncologists =
and not=20
            at a radiology audience.<BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  name=3D"Diffusion and Diffusion Tensor =
Imaging"></A>&nbsp;=BB&nbsp;Diffusion=20
                  and Diffusion Tensor Imaging</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#top"><I=
MG=20
                  alt=3DTop=20
                  =
src=3D"http://www.indianjcancer.com/images/arrow_top.gif"=20
                  =
border=3D0></A></TD></TR></TBODY></TABLE><BR><BR><B>Diffusion Weighted=20
            (DW) Imaging </B><BR><BR>Diffusion-weighted MR imaging is =
the=20
            simplest form of diffusion imaging.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref1"=20
            name=3Dft1>[1]</A></SUP> A diffusion weighted MR sequence is =
an=20
            integral component of the MRI brain protocol for tumors. It =
is a=20
            pulse sequence sensitized to the random motion of water =
molecules=20
            (which is termed '<FONT class=3Dspl>&nbsp;Brownian=20
            motion&nbsp;</FONT><A=20
            href=3D"javascript:openWin('speciallinks.asp?id=3D4606')" =
;><FONT=20
            class=3Dother><SUP>More Details</SUP></FONT></A>'). Certain=20
            pathologies constrain the normal random motion of water =
molecules in=20
            the brain tissue and this is referred to as 'restricted =
diffusion'.=20
            Diffusion weighting enables one to distinguish between rapid =

            diffusion of protons (unrestricted diffusion) and slow =
diffusion of=20
            protons (restricted diffusion). Lesions that have restricted =

            diffusion appear hyperintense on diffusion images and =
hypointense on=20
            the accompanying apparent diffusion coefficient (ADC) maps. =
Using an=20
            ADC map it is possible to quantify the diffusion in brain=20
            tissues.<BR><BR><B>Applications of DW imaging<BR><BR></B>The =

            prototype pathology that markedly displays restricted =
diffusion is=20
            the hyperacute arterial infarct where the bright signal on =
DW images=20
            or low ADC values are attributed to cytotoxic edema. In =
brain=20
            tumors, diffusion imaging is helpful in the preoperative,=20
            noninvasive, radiological grading of gliomas.<SUP> <A =
class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref2"=20
            name=3Dft2>[2]</A></SUP> Restricted diffusion or low ADC in =
the=20
            peripheral, solid component of a glioma is known to =
correspond to=20
            higher grades, which include anaplastic astrocytoma and =
glioblastoma=20
            multiforme (GBM), whereas, low-grade fibrillary astrocytomas =
display=20
            increased diffusivity. The low ADC of the solid peripheral=20
            components of high-grade astrocytomas is attributed to=20
            hypercellularity and high nuclear to cytoplasmic =
ratios.Other brain=20
            tumors that characteristically display restricted diffusion =
for the=20
            same reason are lymphoma,<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref3"=20
            name=3Dft3>[3]</A></SUP> medulloblastoma, and =
meningioma.<SUP> <A=20
            class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref4"=20
            name=3Dft4>[4]</A></SUP> The depiction of restricted =
diffusion in a=20
            posterior fossa space occupying lesion (SOL) in a child, =
favors the=20
            diagnosis of medulloblastoma<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref5"=20
            name=3Dft5>[5]</A></SUP> rather than ependymoma. Finally =
epidermoid=20
            cysts almost always display restricted diffusion.<BR><BR>In =
the=20
            setting of a ring enhancing lesion with perilesional edema =
and mass=20
            effect on CT or conventional MRI, it is often not possible =
to=20
            distinguish an abscess from a high-grade necrotic glioma. =
The=20
            presence of a markedly restricted diffusion in the center of =
a ring=20
            enhancing lesion corresponds to pus, and establishes the =
diagnosis=20
            of a cerebral abscess.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref6"=20
            name=3Dft6>[6]</A></SUP> The necrotic fluid in the center of =
a ring=20
            enhancing high-grade astrocytoma almost never displays =
restricted=20
            diffusion. Thus diffusion-weighted images and ADC maps have =
a=20
            reliable role in the diagnosis and grading of brain=20
            tumors.<BR><BR><B>Diffusion Tensor Imaging <BR><BR></B>A =
more=20
            sophisticated extension of diffusion imaging is diffusion =
tensor=20
            imaging.Diffusion tensor MR imaging is the only noninvasive =
<I>in=20
            vivo </I>method for mapping white matter fiber tract =
trajectories in=20
            the human brain.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref7"=20
            name=3Dft7>[7]</A></SUP> Diffusion tensor imaging is based =
on the=20
            concepts of isotropic and anisotropic diffusion. The =
movement of=20
            water molecules occurs in all three directions.When water =
molecules=20
            diffuse equally in all three directions, this is termed as=20
            <I>isotropic diffusion</I> .This is typical in the =
ventricles, but=20
            is also true in the gray matter. In the white matter, free =
water=20
            molecules move <I>anisotropically, </I>that is, water =
diffusion is=20
            not equal in all three directions.This is because, in the =
white=20
            matter tracts, the myelin sheath surrounding the white =
matter causes=20
            the water molecules to move more along the long axis of a =
fiber=20
            bundle and less perpendicularly. Maximum diffusivity =
coincides with=20
            the white matter fiber tract orientation.<BR><BR>Information =
from=20
            DTI is presented in two formats, which are FA (fractional=20
            anisotropy) maps and tractography. FA maps are =
cross-sectional=20
            images that may be in a gray scale format or may be color =
coded for=20
            directional information. FA stands for fractional =
anisotropy.=20
            Structures that have anisotropy, that is, white matter, =
appear=20
            bright on the gray scale FA maps and the degree of =
brightness is=20
            proportional to the anisotropy. When a white matter tract is =

            destroyed by say a tumor, there is loss of anisotropy and =
therefore=20
            a reduction in the FA values, which is manifested on the =
gray scale=20
            FA maps, as loss of brightness. FA values can also be =
quantified=20
            numerically .The color FA maps show the direction of white =
matter=20
            tracts; conventionally, commisural tracts like the corpus =
callosum=20
            are depicted in red, association fibers such as the superior =

            longitudinal fasciculus are displayed in green and the=20
            superoinferiorly running projection fibers are seen in blue. =
Again=20
            the intensity of the color hues is proportional to the =
extent of=20
            anisotopy. In addtion to assessment of the diffusion in a =
single=20
            voxel, DTI has been used to map the white mattter fiber =
tracts.These=20
            3-D reconstructions are called tractography. The principle =
direction=20
            of difffusion in a voxel is called the Eigenvector. =
Tractography is=20
            done by connecting a given voxel to the appropriate adjacent =
voxel,=20
            in accordance with the direction that the voxel's principle=20
            eigenvector is oriented. <BR><BR><B>Applications of=20
            DTI<BR><BR></B>Diffusion tensor imaging has widespread =
applications=20
            in Neurology and Neurosurgical cases. In the current =
clinical=20
            practice, one of the most important indications of DTI is to =
study=20
            the relation of a tumor to the adjacent white matter =
tracts<SUP> <A=20
            class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref8"=20
            name=3Dft8>[8]</A></SUP> <A class=3Dref=20
            =
onmouseover=3D"omovimg('viewimaget.asp?img=3DIndianJournalofCancer_2009_4=
6_2_82_49145_u1.jpg')"=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#">[Figu=
re=20
            1]</A>. White matter involvement by a tumor can be arranged =
into=20
            various categories with DTI, such as, displaced, invaded, =
edematous,=20
            and destroyed white matter tracts. This in turn helps guide =
the=20
            surgical approach and extent of resection.<SUP> <A =
class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref9"=20
            name=3Dft9>[9]</A></SUP> DTI demonstration of the =
corticospinal tracts=20
            is a useful adjunct to intraoperative fiber =
stimulation.<SUP> <A=20
            class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref10" =

            name=3Dft10>[10]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref11" =

            name=3Dft11>[11]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref12" =

            name=3Dft12>[12]</A></SUP> Preoperative tractography showing =
tumor=20
            involvement of the corticospinal tract has been correlated =
to motor=20
            deficits, even when the motor cortex is uninvolved.<SUP> <A=20
            class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref13" =

            name=3Dft13>[13]</A></SUP> Conversely, normalization at =
postoperative=20
            tractography was predictive of improvement in function, =
suggesting a=20
            role for intraoperative tractography.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref14" =

            name=3Dft14>[14]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref15" =

            name=3Dft15>[15]</A></SUP> Thus, diffusion tensor imaging, =
by=20
            improving the recognition and characterization of white =
matter=20
            tracts, offers a glimpse into the brain microstructure at a =
scale=20
            that is not easily accessible with other =
modalities.<BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  name=3D"Perfusion =
Imaging"></A>&nbsp;=BB&nbsp;Perfusion Imaging</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#top"><I=
MG=20
                  alt=3DTop=20
                  =
src=3D"http://www.indianjcancer.com/images/arrow_top.gif"=20
                  =
border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>Perfusion imaging=20
            with CT and MRI is an exciting new radiological technique =
for=20
            noninvasive evaluation of cerebral hemodynamics in certain =
definite=20
            clinical settings. Cerebral perfusion imaging describes the =
passage=20
            of blood through the brain's vascular network. In a CT / MRI =

            perfusion study, an intravenous injection of a contrast =
agent is=20
            followed by serial imaging to track its first pass =
circulation=20
            through the brain tissue capillary bed. Usually a double =
dose of=20
            contrast is employed, which is administered intravenously at =
a very=20
            rapid rate of 3 - 4 ml/second using a pressure injector.=20
            Approximately 700 images are obtained in 1 minute 20 seconds =
on an=20
            average; this raw data is post-processed to obtain =
color-coded maps=20
            of the four perfusion parameters, which are cerebral blood =
volume=20
            (CBV), cerebral blood flow (CBF), mean transit time (MTT), =
and time=20
            to peak (TTP), Arterial spin labeling is a new perfusion =
technique=20
            that does not require exogenous contrast, instead it =
exploits the=20
            spins of endogenous water protons that perfuse the imaging=20
            plane.<BR><BR><B>Applications of Perfusion =
Imaging<BR><BR></B>The=20
            two important clinical settings in which perfusion imaging =
is used=20
            in modern clinical practice are: in the evaluation of brain =
tumors=20
            and for the depiction of the penumbra in hyperacute ischemic =

            strokes, to direct thrombolytic therapy. Over the last =
decade,=20
            advanced MR techniques that produce image contrast, =
reflecting=20
            attributes of tissue physiology and microstructure, have =
begun to be=20
            widely applied in clinical brain tumor imaging at major =
academic=20
            centers.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref16" =

            name=3Dft16>[16]</A></SUP> Perfusion imaging, especially =
with MRI has=20
            become an integral component of the complete radiological =
assessment=20
            of brain tumors. Like all cancers, brain tumors are =
associated with=20
            a high cell turnover, which leads to cellular hypoglycemia =
and=20
            hypoxia. This, in turn, induces the production of the =
vasoactive=20
            endothelial growth factor (VEGF)<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref17" =

            name=3Dft17>[17]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref18" =

            name=3Dft18>[18]</A> </SUP>which leads to neoangiogenesis.=20
            Neoangiogenesis refers to the formation of new dense beds of =

            characteristically tortuous and structurally abnormal =
''corkscrew''=20
            neocapillaries, which produce extremely high blood volume in =
the=20
            local tissue.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref17" =

            name=3Dft17>[17]</A></SUP> Thus, increased capillary density =
in the=20
            tumor environment is the cause of markedly elevated cerebral =
blood=20
            volume (CBV) and cerebral blood flow (CBF) in the tumor, as =
compared=20
            to the contralateral normal brain parenchyma. The new =
vessels are=20
            more tortuous than the native cerebral vessels, leading to =
increased=20
            mean transit times (MTT). Hence perfusion imaging is often =
useful to=20
            establish the diagnosis of tumor and to distinguish tumor =
from tumor=20
            mimics, such as, infective granulomas and tumefactive =
demyelination,=20
            which are hypoperfused with low values of CBV, CBF, and MTT. =

            <BR><BR>Furthermore, numerous studies<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref19" =

            name=3Dft19>[19]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref20" =

            name=3Dft20>[20]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref21" =

            name=3Dft21>[21]</A></SUP> have shown that perfusion imaging =
can=20
            noninvasively grade tumor histology preoperatively. =
Low-grade=20
            astrocytomas are hypoperfused as compared to grade III and =
IV=20
            lesions <A class=3Dref=20
            =
onmouseover=3D"omovimg('viewimaget.asp?img=3DIndianJournalofCancer_2009_4=
6_2_82_49145_u2.jpg')"=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#">[Figu=
re=20
            2]</A>. Upto one-third of the high-grade tumors do not =
enhance on=20
            post contrast T1 weighted images, which may lead to a false=20
            radiological impression of low grade; unless a perfusion =
study is=20
            performed, which demonstrates hyperperfusion due to =
neoangiogenesis,=20
            which is associated with higher grade.<BR><BR>Some =
authors<SUP> <A=20
            class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref22" =

            name=3Dft22>[22]</A> </SUP>have suggested that MR perfusion =
along with=20
            spectroscopy may aid in differentiating a high-grade primary =
tumor=20
            from solitary cerebral metastasis. Primary high-grade tumors =
are=20
            infiltrative by nature, hence the peritumoral edema shows =
elevated=20
            CBV values. In contrast, metastases are well encapsulated =
and=20
            noninfiltrative by nature and hence the perilesional edema =
being=20
            purely vasogenic shows low CBV values. MR perfusion may also =
be used=20
            as a guide to direct stereotactic biopsies from the most =
aggressive=20
            component of a heterogeneous tumor. Upto one-third of =
high-grade=20
            tumors are under-reported at stereotactic biopsy and this =
may be=20
            because the biopsy has not been acquired from the most =
aggressive=20
            portion of the lesion.<BR><BR>MR perfusion can help =
distinguish=20
            gliomas from nonglial lesions like lymphoma and metastases =
or=20
            extra-axial tumors like meningioma.This is because =
extra-axial=20
            tumors and nonglial lesions lack a blood brain barrier =
(BBB), hence,=20
            a very large fraction of the bolus leaks into the =
extravascular=20
            space during the first pass.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref23" =

            name=3Dft23>[23]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref24" =

            name=3Dft24>[24]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref25" =

            name=3Dft25>[25]</A></SUP> On the other hand, gliomas have a =
BBB that=20
            is impaired but not absent and this reflects in the =
perfusion data.=20
            The difference between these perfusion patterns can =
contribute=20
            significantly to the discrimination of tumor types in cases =
of=20
            peripherally located enhancing tumors when the differential=20
            diagnosis includes meningioma and peripheral GBM, and in=20
            periventricular enhancing lesions when the differential =
diagnosis=20
            includes choroid plexus papillocarcinoma and GBM.<SUP> <A =
class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref17" =

            name=3Dft17>[17]</A></SUP> It has been reported that MR =
perfusion is=20
            more accurate in determining the true anatomical extent of a =
lesion=20
            as compared to conventional imaging.This is because the =
perilesional=20
            edema often contains microscopic tumors, which manifest on =
perfusion=20
            studies as areas of increased CBV. Hence perfusion maps may =
show=20
            true tumor margins beyond what is visible on conventional MR =

            imaging. The demonstration of the true anatomical extent of =
a tumor=20
            aids in proper surgical and radiation therapy=20
            planning.<BR><BR>Perfusion imaging is excellent in the=20
            differentiation of tumor recurrence from radiation necrosis, =
which=20
            can be confusing on conventional MR imaging. On conventional =

            imaging, both recurrent high-grade tumor and radiation =
necrosis=20
            appear as space occupative lesions with post contrast =
enhancement,=20
            perilesional edema, mass effect, and intralesional =
hemorrhage.=20
            Furthermore, for reasons not well understood, radiation =
necrosis=20
            most commonly occurs in the tumor bed, even in cases of =
whole brain=20
            irradiation. However, radiation therapy leads to =
endarteritis and=20
            therefore the lesions of radiation necrosis are =
hypoperfused,=20
            whereas, recurrent tumor being most often high-grade, is=20
            hyperperfused.<BR><BR>Finally, it is expected, that in the =
future,=20
            perfusion imaging may be a surrogate marker to study =
response in=20
            clinical trials of newer antiangiogenic =
pharmaceuticals.<BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  name=3D"MR Spectroscopy"></A>&nbsp;=BB&nbsp;MR =
Spectroscopy</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#top"><I=
MG=20
                  alt=3DTop=20
                  =
src=3D"http://www.indianjcancer.com/images/arrow_top.gif"=20
                  border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>MRS =
is the only=20
            noninvasive technique capable of measuring chemicals within =
the=20
            body. MRS distinguishes various metabolites on the basis of =
their=20
            slightly different chemical shifts or resonance frequencies. =

            Biologically, relevant nuclei that are amenable to MR =
analysis are=20
            those with an odd number of protons and neutrons, such as,=20
            <SUP>1</SUP> H<SUP> </SUP>,<SUP> 31</SUP> P<SUP> =
</SUP>,<SUP>=20
            13</SUP> C , <SUP>19</SUP> F, and <SUP>23</SUP> Na. Of =
these, the=20
            one we commonly use is hydrogen or proton spectroscopy. The=20
            metabolic information received is displayed as a graph. On =
the=20
            x-axis are plotted the resonance frequencies, which allow us =
to=20
            identify each unique metabolite. These frequencies are =
plotted in an=20
            unit called parts per million (ppm). Using the y-axis, it is =

            possible to quantify the metabolite by either measuring the =
peak=20
            value referred to as the amplitude, or the area under the =
curve,=20
            called the integral value. Various ratios are often =
calculated.=20
            Single or multiple voxels of the brain can be interrogated =
with this=20
            technique. Multivoxel spectroscopy is also called chemical =
shift=20
            imaging or CSI. With CSI it is possible to create visually =
appealing=20
            color maps or metabolite maps, for spatial demonstration of =
the=20
            metabolite peaks and ratios. These color maps are overlapped =
or=20
            fused with conventional MR techniques to improve anatomical=20
            localization.<BR><BR><B>Applications of MR=20
            Spectroscopy<BR><BR></B>Clinically relevant metabolites that =
feature=20
            on the brain spectral graph are branch-chained amino acids =
(appear=20
            at 0.9 to 1.0 ppm on the x-axis), lipid (0.9 to 1.5 ppm), =
lactate=20
            (1.3 ppm), alanine (1.5 ppm), N-acetyl aspartate (2.0 ppm), =
choline=20
            (3.2 ppm), creatine (3.0 and 3.9 ppm), and myoinositol (3.6 =
ppm). MR=20
            spectroscopy is useful in establishing the diagnosis of =
tumor by=20
            demonstration of elevated choline, a metabolite that is =
found in the=20
            normal brain and raised in tumors due to high cell turnover. =
The=20
            characteristic spectral graph of a glioma depicts depressed =
N-acetyl=20
            aspartate (NAA), a neuronal marker, elevated choline, and =
lipid and=20
            / or lactate peaks <A class=3Dref=20
            =
onmouseover=3D"omovimg('viewimaget.asp?img=3DIndianJournalofCancer_2009_4=
6_2_82_49145_u3.jpg')"=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#">[Figu=
re=20
            3]</A>. It is thus possible to separate tumors from tumor =
mimics=20
            like granuloma and radiation necrosis, which are not =
associated with=20
            markedly elevated choline. It is also useful in the =
differential=20
            diagnosis of brain SOLs, for example, elevated alanine is a =
marker=20
            for meningioma. Along with MR perfusion, spectroscopic =
analysis of=20
            the pertumoral edema may help to differentiate high-grade =
glioma=20
            from solitary cerebral metastases,<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref22" =

            name=3Dft22>[22]</A></SUP> when there is a doubt on =
conventional MRI.=20
            The demonstration of elevated choline in peritumoral edema =
suggests=20
            a diagnosis of primary glioma rather than metastases. This =
may be=20
            ascribed to the infiltrative nature of primary high-grade =
cerebral=20
            gliomas. Certain authors have advocated the use of MR =
spectroscopy=20
            for biopsy guidance from the most metabolically active area =
of the=20
            tumor, that is, the area with highest choline.<SUP> <A =
class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref26" =

            name=3Dft26>[26]</A>,<A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref27" =

            name=3Dft27>[27]</A></SUP> However the benefit of using =
spectroscopy=20
            in this setting has not been unequivocally established. The=20
            disadvantages of MR spectroscopy are that it suffers from =
poor=20
            spatial resolution and may sometimes by =
nonspecific.<BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  name=3D"Functional MRI (F =
MRI)"></A>&nbsp;=BB&nbsp;Functional MRI=20
                  (F MRI)</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#top"><I=
MG=20
                  alt=3DTop=20
                  =
src=3D"http://www.indianjcancer.com/images/arrow_top.gif"=20
                  =
border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>Functional MRI refers=20
            to the demonstration of brain function with neuroanatomic=20
            localization on a real-time basis.The vast majority of these =
studies=20
            are performed using blood oxygen level-dependent contrast or =
BOLD,=20
            which requires the detection of very small signal intensity =
changes=20
            - 0-3% at 1.5 Tesla and up to 6% at 3 Tesla for voxel =
volumes as=20
            small as 3 x 3 x 5 mm.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref28" =

            name=3Dft28>[28]</A></SUP> The principle of the BOLD =
technique of F=20
            MRI is that performing a predefined cognitive task leads to=20
            regionally increased neuronal activity and localized =
hemodynamic=20
            changes that produce a signal =
response.<BR><BR><B>Applications of=20
            Functional MRI<BR><BR></B>In patient care, functional MR =
imaging is=20
            primarily used for the preoperative evaluation of<I> </I>the =

            relationship of a brain tumor with an eloquent cortex.<SUP> =
<A=20
            class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref29" =

            name=3Dft29>[29]</A></SUP> The correlating function on =
conventional=20
            anatomical images is inaccurate due to significant =
variability and=20
            displacement of functional areas, as a result of the mass =
effect=20
            from a lesion.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref30" =

            name=3Dft30>[30]</A></SUP> Although functional MR imaging =
cannot yet=20
            replace intraoperative electrocortical stimulation in =
patients=20
            undergoing neurosurgery, it may be useful for guiding =
surgical=20
            planning and mapping, thereby, reducing the extent and =
duration of=20
            craniotomy.<SUP> <A class=3Dref=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ref31" =

            name=3Dft31>[31]</A></SUP> <BR><BR>In addition, hemispheric =
dominance=20
            for language processing needs to be established =
preoperatively in=20
            both brain tumor patients and patients with temporal lobe =
epilepsy.=20
            A preoperative functional MR imaging study of language =
processing=20
            provides information on the feasibility of surgery and =
allows=20
            adequate assessment of the risk of postoperative =
neurological=20
            deficits. A current limitation of functional MRI is that it =
is=20
            unable to distinguish between critical areas, whose =
resection would=20
            lead to permanent disability, from accessory or modulatory =
brain=20
            regions that may be resected without significant =
postoperative=20
            disability.<BR><BR><BR>
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub><A=20
                  name=3DConclusions></A>&nbsp;=BB&nbsp;Conclusions</TD>
                <TD class=3Dinthis align=3Dright>&nbsp;</TD>
                <TD align=3Dright width=3D"15%"><A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#top"><I=
MG=20
                  alt=3DTop=20
                  =
src=3D"http://www.indianjcancer.com/images/arrow_top.gif"=20
                  border=3D0></A></TD></TR></TBODY></TABLE><BR><BR>The =
past few decades=20
            have witnessed the dramatic development of a variety of new =
imaging=20
            techniques for the complete anatomical, biochemical, and=20
            pathophysiological assessment of a brain tumor. These =
techniques=20
            have important implications in planning therapy and in=20
            prognostication.The next decade will witness further =
sophistication=20
            of these techniques and with data available from larger =
studies, it=20
            is expected that imaging will continue to provide new and =
unique=20
            insights in Neuro-oncology which should hopefully contribute =
to the=20
            better management of patients with brain =
tumors.<BR><BR>&nbsp;
            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub height=3D15><A=20
                  name=3DReference></A>&nbsp;=BB&nbsp;References</TD>
                <TD class=3Dinthis align=3Dright height=3D15>&nbsp;</TD>
                <TD align=3Dright width=3D"15%" height=3D15><A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#top"><I=
MG=20
                  alt=3DTop=20
                  =
src=3D"http://www.indianjcancer.com/images/arrow_top.gif"=20
                  border=3D0></A></TD></TR></TBODY></TABLE><BR>
            <TABLE class=3Dbody cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
              border=3D0><TBODY>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft1"=20
                  name=3Dref1>1.</A></TD>
                <TD>Schaefer PW, Grant PE, Gonzalez RG. =
Diffusion-weighted MR=20
                  imaging of the brain. Radiology =
2000;217:331-45.&nbsp;&nbsp;<A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft1"><I=
MG=20
                  alt=3D"Back to cited text no. 1"=20
                  =
src=3D"http://www.indianjcancer.com/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;[<A=20
                  =
href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&amp;=
db=3DPubMed&amp;list_uids=3D11058626&amp;dopt=3DAbstract"=20
                  target=3D_blank><FONT=20
                  class=3Dref>PUBMED</FONT></A>]&nbsp;&nbsp;[<A=20
                  =
href=3D"http://radiology.rsnajnls.org/cgi/pmidlookup?view=3Dlong&amp;pmid=
=3D11058626"=20
                  target=3D_blank><FONT =
class=3Dref>FULLTEXT</FONT></A>]</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
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href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft2"=20
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                <TD>Castillo M, Smith JK, Kwock L, Wilber K. Apparent=20
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                  cerebral gliomas. AJNR Am J Neuroradiol=20
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href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft2"><I=
MG=20
                  alt=3D"Back to cited text no. 2"=20
                  =
src=3D"http://www.indianjcancer.com/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;[<A=20
                  =
href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&amp;=
db=3DPubMed&amp;list_uids=3D11158889&amp;dopt=3DAbstract"=20
                  target=3D_blank><FONT=20
                  class=3Dref>PUBMED</FONT></A>]&nbsp;&nbsp;[<A=20
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href=3D"http://www.ajnr.org/cgi/pmidlookup?view=3Dlong&amp;pmid=3D1115888=
9"=20
                  target=3D_blank><FONT =
class=3Dref>FULLTEXT</FONT></A>]</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
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href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft3"=20
                  name=3Dref3>3.</A></TD>
                <TD>Guo AC, Cummings TJ, Dash RC, Provenzale JM. =
Lymphomas and=20
                  high-grade astrocytomas: Comparison of water =
diffusibility and=20
                  histologic characteristics. Radiology=20
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                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft3"><I=
MG=20
                  alt=3D"Back to cited text no. 3"=20
                  =
src=3D"http://www.indianjcancer.com/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;[<A=20
                  =
href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&amp;=
db=3DPubMed&amp;list_uids=3D12091680&amp;dopt=3DAbstract"=20
                  target=3D_blank><FONT=20
                  class=3Dref>PUBMED</FONT></A>]&nbsp;&nbsp;[<A=20
                  =
href=3D"http://radiology.rsnajnls.org/cgi/pmidlookup?view=3Dlong&amp;pmid=
=3D12091680"=20
                  target=3D_blank><FONT =
class=3Dref>FULLTEXT</FONT></A>]</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft4"=20
                  name=3Dref4>4.</A></TD>
                <TD>Filippi CG, Edgar MA,Ulug AM, Prowda JC, Heier LA,=20
                  Zimmerman RD. Appearance of meningiomas on =
diffusion-weighted=20
                  images: Correlating diffusion constants with =
histopathologic=20
                  findings. AJNR Am J Neuroradiol =
2001;22:65-72.&nbsp;&nbsp;<A=20
                  =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft4"><I=
MG=20
                  alt=3D"Back to cited text no. 4"=20
                  =
src=3D"http://www.indianjcancer.com/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
              <TR>
                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
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MG=20
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                  target=3D_blank><FONT =
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft7"=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft7"><I=
MG=20
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                  =
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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1064&amp;spage=3D193"=20
                  target=3D_blank><FONT =
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                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
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href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft8"=20
                  name=3Dref8>8.</A></TD>
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft8"><I=
MG=20
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                  =
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
                  =
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db=3DPubMed&amp;list_uids=3D16908551&amp;dopt=3DAbstract"=20
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1"=20
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                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft9"=20
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MG=20
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft10"=20
                  name=3Dref10>10.</A></TD>
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IMG=20
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                  border=3D0></A>&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft12"=20
                  name=3Dref12>12.</A></TD>
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft13"=20
                  name=3Dref13>13.</A></TD>
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft13"><=
IMG=20
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                  =
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft14"=20
                  name=3Dref14>14.</A></TD>
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft14"><=
IMG=20
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft15"=20
                  name=3Dref15>15.</A></TD>
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IMG=20
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                  =
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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href=3D"http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/m=
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft16"=20
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IMG=20
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                  =
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IMG=20
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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                  border=3D0></A>&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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src=3D"http://www.indianjcancer.com/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
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                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
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                  border=3D0></A>&nbsp;&nbsp;[<A=20
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db=3DPubMed&amp;list_uids=3D11489736&amp;dopt=3DAbstract"=20
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                <TD vAlign=3Dtop width=3D"5%"><A class=3Dref=20
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href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft30"=20
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2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#ft30"><=
IMG=20
                  alt=3D"Back to cited text no. 30"=20
                  =
src=3D"http://www.indianjcancer.com/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;[<A=20
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IMG=20
                  alt=3D"Back to cited text no. 31"=20
                  =
src=3D"http://www.indianjcancer.com/images/ref_top.gif"=20
                  border=3D0></A>&nbsp;&nbsp;[<A=20
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href=3D"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&amp;=
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            <TABLE class=3DleftNav cellSpacing=3D0 cellPadding=3D0 =
width=3D"100%"=20
            border=3D0>
              <TBODY>
              <TR>
                <TD class=3DpageSub>&nbsp;&nbsp;&nbsp;&nbsp;<A=20
                  =
name=3Dafigs></A>Figures</TD></TR></TBODY></TABLE><BR>&nbsp; <A=20
            class=3Dref=20
            =
onmouseover=3D"omovimg('viewimaget.asp?img=3DIndianJournalofCancer_2009_4=
6_2_82_49145_u1.jpg"=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#"=20
            target=3D_blank>[Figure 1]</A>, <A class=3Dref=20
            =
onmouseover=3D"omovimg('viewimaget.asp?img=3DIndianJournalofCancer_2009_4=
6_2_82_49145_u2.jpg"=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#"=20
            target=3D_blank>[Figure 2]</A>, <A class=3Dref=20
            =
onmouseover=3D"omovimg('viewimaget.asp?img=3DIndianJournalofCancer_2009_4=
6_2_82_49145_u3.jpg"=20
            =
href=3D"http://www.indianjcancer.com/article.asp?issn=3D0019-509X;year=3D=
2009;volume=3D46;issue=3D2;spage=3D82;epage=3D87;aulast=3DSanghvi#"=20
            target=3D_blank>[Figure 3]</A>=20
            <TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" =
border=3D0>
              <TBODY>
              <TR>
                <TD width=3D"100%">
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                  =
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<P class=3DpageSub align=3Dcenter><B>Figures and Tables</B></P>
<P align=3Dcenter><A=20
href=3D"http://www.indianjcancer.com/viewimage.asp?img=3DIndianJournalofC=
ancer_2009_46_2_82_49145_u1.jpg"=20
target=3D_blank><IMG=20
style=3D"BORDER-RIGHT: #cccccc 1px solid; BORDER-TOP: #cccccc 1px solid; =
BORDER-LEFT: #cccccc 1px solid; BORDER-BOTTOM: #cccccc 1px solid"=20
height=3D150 alt=3D""=20
src=3D"http://www.indianjcancer.com/articles/2009/46/2/images/IndianJourn=
alofCancer_2009_46_2_82_49145_u1.jpg"=20
width=3D126></A><BR><FONT class=3Dadlink>Figure 1: Right frontal lobe=20
c...</FONT></P>
<P align=3Dcenter><A=20
href=3D"http://www.indianjcancer.com/viewimage.asp?img=3DIndianJournalofC=
ancer_2009_46_2_82_49145_u2.jpg"=20
target=3D_blank><IMG=20
style=3D"BORDER-RIGHT: #cccccc 1px solid; BORDER-TOP: #cccccc 1px solid; =
BORDER-LEFT: #cccccc 1px solid; BORDER-BOTTOM: #cccccc 1px solid"=20
height=3D83 alt=3D""=20
src=3D"http://www.indianjcancer.com/articles/2009/46/2/images/IndianJourn=
alofCancer_2009_46_2_82_49145_u2.jpg"=20
width=3D150></A><BR><FONT class=3Dadlink>Figure 2: T2 weighted image=20
(A...</FONT></P>
<P align=3Dcenter><A=20
href=3D"http://www.indianjcancer.com/viewimage.asp?img=3DIndianJournalofC=
ancer_2009_46_2_82_49145_u3.jpg"=20
target=3D_blank><IMG=20
style=3D"BORDER-RIGHT: #cccccc 1px solid; BORDER-TOP: #cccccc 1px solid; =
BORDER-LEFT: #cccccc 1px solid; BORDER-BOTTOM: #cccccc 1px solid"=20
height=3D77 alt=3D""=20
src=3D"http://www.indianjcancer.com/articles/2009/46/2/images/IndianJourn=
alofCancer_2009_46_2_82_49145_u3.jpg"=20
width=3D150></A><BR><FONT class=3Dadlink>Figure 3: T2 weighted image=20
(A...</FONT></P></BODY></HTML>

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