Imaging of Brain Tumor Connectivity.

Brain tumors, especially glioblastomas, remain among the tumor diseases with the worst prognosis. Recent findings in brain tumor research show that neuronal and glial integration of tumors, as well as the formation of glioma cell networks, promote tumor progression and therapy resistance. This highlights the need for innovative imaging techniques that conceptualize brain tumors as systemic central nervous system (CNS) diseases that are deeply integrated in the brain's network architecture.This review presents current imaging methods for analyzing tumor-associated functional and structural connectivity with a focus on resting-state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI).Functional connectivity changes in glioma patients can be detected and quantified using fMRI. These changes are associated with tumor biology, as well as prognosis and cognitive performance. Rs-fMRI parameters may support prognostic assessment and the development of new therapeutic strategies. Quantitative structural connectivity analysis at the individual patient level can provide further insight into tumor integration in the brain's connectional architecture. DTI-based tractography is especially relevant in neurosurgical planning, as it maps the spatial relationship between the tumor and white matter tracts.Imaging analysis of tumor-associated network alterations provides deeper insight into brain tumor biology and may support the development of network-targeted therapeutic approaches. Connectivity-based imaging methods, particularly rs-fMRI and DTI, hold great potential to further enhance preoperative planning, prognostic assessment, and personalized treatment strategies for patients with brain tumors. · Glioma cells form networks beyond macroscopic tumor boundaries and promote therapy resistance.. · Glioma cells form synapses with neurons and exploit neural signals for growth.. · Network alterations can be visualized and quantified using rs-fMRI and DTI.. · Tumor-associated network alterations in imaging correlate with tumor biology and prognosis.. · Imaging markers optimize patient management and support development of new therapeutic strategies.. · Suvak S, Wunderlich S, Stoecklein V et al. Imaging of Brain Tumor Connectivity. Rofo 2026; DOI 10.1055/a-2779-7718.