A comprehensive neuroimaging review of the primary and metastatic brain tumors treated with immunotherapy: current status, and the application of advanced imaging approaches and artificial intelligence

Xiang Liu; Hongyan Chen; Guirong Tan; Lijuan Zhong; Haihui Jiang; Stephen M Smith; Henry Z Wang

doi:10.3389/fimmu.2024.1496627

A comprehensive neuroimaging review of the primary and metastatic brain tumors treated with immunotherapy: current status, and the application of advanced imaging approaches and artificial intelligence

Front Immunol. 2024 Nov 28:15:1496627. doi: 10.3389/fimmu.2024.1496627. eCollection 2024.

Authors

Xiang Liu^{1

2}, Hongyan Chen³, Guirong Tan^{1

2}, Lijuan Zhong⁴, Haihui Jiang⁵, Stephen M Smith⁶, Henry Z Wang⁶

Affiliations

¹ Department of Radiology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong, China.
² Advanced Neuroimaging Laboratory, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong, China.
³ Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Pathology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong, China.
⁵ Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.
⁶ Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States.

Abstract

Cancer immunotherapy has emerged as a novel clinical therapeutic option for a variety of solid tumors over the past decades. The application of immunotherapy in primary and metastatic brain tumors continues to grow despite limitations due to the physiological characteristics of the immune system within the central nervous system (CNS) and distinct pathological barriers of malignant brain tumors. The post-immunotherapy treatment imaging is more complex. In this review, we summarize the clinical application of immunotherapies in solid tumors beyond the CNS. We provide an overview of current immunotherapies used in brain tumors, including immune checkpoint inhibitors (ICIs), oncolytic viruses, vaccines, and CAR T-cell therapies. We focus on the imaging criteria for the assessment of treatment response to immunotherapy, and post-immunotherapy treatment imaging patterns. We discuss advanced imaging techniques in the evaluation of treatment response to immunotherapy in brain tumors. The imaging characteristics of immunotherapy treatment-related complications in CNS are described. Lastly, future imaging challenges in this field are explored.

Keywords: MR perfusion imaging; advanced imaging; brain metastasis; immunotherapy; malignant glioma; pseudoprogression; tumor progression.

Publication types

Review

MeSH terms

Animals
Artificial Intelligence*
Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / immunology
Brain Neoplasms* / secondary
Brain Neoplasms* / therapy
Humans
Immune Checkpoint Inhibitors / therapeutic use
Immunotherapy* / methods
Neuroimaging* / methods
Treatment Outcome

Substances

Immune Checkpoint Inhibitors

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Project Supported for Scientists in the Bureau of Science and Technology of ShaoGuan (Grant No. 230329238033088). Project Supported for Scientists in the Bureau of Science and Technology of ShaoGuan (Grant No. 220531214533619). Project Supported for the National Natural Science Foundation of China (No. 82202983). Project Supported for the Peking University Clinical Scientist Training Program, funded by the Fundamental Research Funds for the Central Universities.