MRI在鉴别胶质母细胞瘤治疗相关反应与复发中的应用进展  

Progress of MRI in differentiating treatment-related changes and recurrence of glioblastoma

作　　者：朱正阳 韩小伟 叶梅萍 陈思璇 张鑫[1] 张冰[1,2,3,4] ZHU Zhengyang;HAN Xiaowei;YE Meiping;CHEN Sixuan;ZHANG Xin;ZHANG Bing(Department of Radiology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210093,China;Institute of Medical Imaging and Artificial Intelligence,Nanjing University,Nanjing 210093,China;Jiangsu Key Laboratory of Molecular Medicine,Nanjing 210093,China;Institute of Brain Science,Nanjing University,Nanjing 210093,China)

机构地区：[1]南京大学医学院附属鼓楼医院医学影像科,南京210093 [2]南京大学医学影像与人工智能研究所,南京210093 [3]江苏省医学分子技术重点实验室,南京210093 [4]南京大学脑科学研究院,南京210093

出　　处：《磁共振成像》2023年第4期147-153,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(编号:81971596)。

摘　　要：胶质母细胞瘤(glioblastoma multiforme, GBM)是最常见的原发性中枢神经系统恶性肿瘤,目前临床常用治疗手段包括手术切除及后续的放化疗。GBM患者接受放疗和化疗后出现的相关反应包括假性进展、放射性坏死和假性反应,因其与肿瘤复发的影像学表现相似导致在临床上常易混淆。GBM治疗相关反应与肿瘤复发的准确诊断与鉴别有助于及时评估患者疾病进展、制订治疗方案和提高治疗效果,对改善患者预后和远期生存期至关重要。本文简要阐述了磁共振常规成像和高级成像技术如弥散加权成像、弥散张量成像、弥散峰度成像、动态磁敏感对比增强成像、动态对比增强成像、动脉自旋标记、磁共振波谱、酰胺质子转移成像等在鉴别GBM治疗相关反应与复发中的应用进展。本文将帮助临床医生和科研人员理解GBM复发与治疗相关反应影像学表现的差异以及相关血流动力学、代谢水平及组织微结构的差异,进而提高GBM患者总体预后,也为后续磁共振新技术在该领域中的应用奠定基础。Glioblastoma multiforme(GBM)is the most common primary central nervous system malignancy.Current treatment options include surgical resection and subsequent chemotherapy and radiation therapy.Treatment-related changes often occur after treatment of GBM,including pseudoprogression,radiation necrosis and pseudoresponse.Treatment-related changes and tumor recurrence can be confused clinically due to similar image findings.Accurate identification and diagnosis of treatment-related changes and recurrences of GBM contributes to timely assessment of disease progression,adjustment of treatment regimens,improvement of therapeutic effects,and is crucial for improving patient prognosis and long-term survival.This paper briefly reviewed the progress of magnetic resonance techniques such as conventional magnetic resonance imaging,diffusion weighed imaging,diffusion tensor imaging,diffusion kurtosis imaging,dynamic susceptibility contrast-enhanced imaging,dynamic contrast enhanced,arterial spin labeling,magnetic resonance spectrum,amide proton transfer,etc in differentiating treatment-related changes and recurrence of GBM.This review will help clinicians and researchers better understand the differences of image manifestation and the differences of hemodynamics,metabolic level and histological microstructure between GBM recurrence and treatment-related changes.This review will further help improve the overall prognosis of GBM patients and lay the foundation for the subsequent application of new magnetic resonance technology in this field.

关 键 词：胶质母细胞瘤 磁共振成像 治疗相关反应 假性进展 放射性坏死 假性反应 复发 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.264[医药卫生—诊断学]