Mapping Molecular Markers of Brain Tumour Activity Using MRI

Patients recruited into this study will be those for whom a surgical resection or biopsy of a primary brain tumour has already been planned by the King's College Hospital Neuro-oncology team. All patients in the UK arm of this international study will be recruited at the King's College Hospital site. Research imaging performed on patients enrolled in this study will take place at the Guy's and St Thomas' Hospital site.

For patients who have consented to be included in our research study, novel MRI techniques will be included in addition to the standard primary brain tumour imaging protocol, to provide additional information about the nature of the primary tumour: for example, the structural components and metabolism.

The MRI scan will last approximately 60 minutes, which is approximately 30 minutes longer than the standard brain tumour biopsy protocol. Further MRI scans will be performed after surgery and, if necessary, at recurrence (up to a maximum of three scans per patient) to look at advanced imaging changes at each time-point alongside structural changes. These additional scans should also last a maximum of 60 minutes.

All patients will undergo surgery for biopsy/resection of the tumour as part of the standard of care. All routine surgical procedures, pre-surgical and post-surgical care will take place predominantly at King's College Hospital site. Before craniotomy takes place for tumour resection, the neurosurgeon will take 3 tissue samples of the tumour. This will occur via stereotactic (computer-guided) biopsies. A needle will be guided through to a location of interest determined by the novel MRI techniques. This should result in an extension of the surgery time of approximately 30 minutes (10 minutes per biopsy), in addition to the approximately 4 hours needed for the surgery.

After removal, each biopsy specimen is put into a suitable container for preservation. The container will be de-identified and shipped to the Department of Pathology, Erasmus University Rotterdam, The Netherlands where the specimen will be securely stored.

The samples will be cut and slide-mounted for staining. When looking at the specimen under a microscope, particular features which suggest how aggressive the tumour is will be looked for. Information gathered from the tissue biopsies will then be compared and matched to information on the original MRI scan to see whether the novel images obtained can accurately predict the aggressiveness of different parts of the tumour.

Inclusion criteria

• Individuals of 18 years or older
• Referred for surgery (resection or biopsy) of primary brain tumour
• Written informed consent

Exclusion criteria

• Contra-indication for MRI contrast
• Inability to give consent
• Have received/are receiving chemotherapy at time of MRI
• Patient is pregnant or planning to become pregnant