When contouring gliomas, how do you distinguish true tumor-related FLAIR from ischemic changes from prior strokes?

FLAIR alone often cannot reliably distinguish infiltrative tumor from chronic/subacute ischemic change. In a patient with a glioma and a previous stroke, the distinction should be made using the pattern of the FLAIR, temporal evolution, diffusion, perfusion, and sometimes metabolic imaging. The temporal evolution is particularly helpful. A stroke that is stable or becoming progressively more atrophic over months is very different from FLAIR that is becoming progressively more expansive. Access to prior brain MRIs obtained at the time of the stroke is going to be the key to interpreting the new FLAIR images related to the glioma diagnosis and therefore will determine the contouring of the treatment target. Below are some suggestions which ma...

I rely on diagnostic radiologist discussions.