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Okay, great.

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Well, thank you so much for having me today.

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Um, hello everyone out there.

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I'm going to talk about some brain tumor imaging in the

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context of W-H-O-C-N-S tumor classification.

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So objective today is to, I'm going to highlight couple

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of key points from the 2021 W-H-O-C-N-S tumor classification

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and really morph that into how is that relevant

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to neural radiologist

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or general radiologists who are looking at brain MRIs

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or spine MRIs for patients with brain tumor.

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And I'm going to just illustrate some of the correlation

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of molecular genetic markers in terms of

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what are you looking for on imaging,

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because we are non neuropathologists,

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we're not basic biologists,

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but we must keep abre

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with this explosive knowledge coming from the biological

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side because it does have implication for imaging.

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So the three things that I'm going

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to highlight is W-H-O-C-N-S classification

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and neuroimaging techniques that most

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of you are very familiar with,

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but put that in the context

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of the molecular generic era of brain tumors.

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And then I'm just gonna show you, uh, case by case

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how things are relevant.

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Imaging and neuropathology,

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neuro molecular genetics are intertwined.

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So first, let's start with CNS who classification.

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So some of you are already familiar

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that World Health Organization has been supporting, uh,

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classification of not just brain tumors,

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but all tumors for CNS tumors.

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The first version came out back in 1979

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and 2000 up to 2007.

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And the one, these four classification schemes were purely

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based on histological.

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And then something magical

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or something, uh, really groundbreaking happened in 2016

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classification where molecular

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genetic information became part of the official

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classification system.

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So no longer just the histopathologic features

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of tumor was used to classify tumor.

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Now, there is this very,

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very advanced technique looking at molecular genetics.

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But more interesting to us radiologists, is that

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for the first time ever since 1979,

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MRI image made it to the cover of this book.

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And then fast forward five years later, 2021

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WHO Classification, the fifth edition was published.

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And you could see that now we have two MRI images.

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So imaging is now really gaining attention

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to our neuropathology, our neuropathology

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and neurobiology colleagues.

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That imaging plays a such an important role of

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how we actually look at tumors.

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So we are well on our way to becoming a very important,

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We were already were,

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but now we are pushing towards being part

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of the classification of CNS tumors.

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So the nutshell of WHO 2021 is

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that there are molecular markers everywhere.

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And this is the cartoon I made,

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and it seems like it's,

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we are just touching the tip of the iceberg.

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And these, these are some of the id, um, molecular markers

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that are part of now ordinary conversation in tumor board.

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But there are actually many, many more to come

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and they're already here.

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And next version of, uh, CNS classification,

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which will be coming in maybe five to seven years,

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we are going to see even more.

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So what does this mean for radiologists?

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We just have to make sure that we know

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what is changing the field of classification of CNS tumors

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so that we could keep up with, uh, how we interpret imaging.

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So here's the nutshell of CNSU.

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There are so many molecular markers

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and we're gonna, I'm only gonna touch on

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the several really important ones today.

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And at UCSF, uh, instead

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of just getting a histopathological report,

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we get something like this.

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This is called UCSF 500 gene Panel,

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where we actually get not just a histological diagnosis,

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but we get IDH status.

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But in addition to that, we get whole host

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of additional information.

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And this is really becoming a part of our standard of care

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for brain tumor, uh, pathological diagnosis.