Henson John W, Gaviani Paola, Gonzalez R Gilberto
Division of Neuroradiology and Steven E and Catherine Pappas, Center for Neuro-oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
Lancet Oncol. 2005 Mar;6(3):167-75. doi: 10.1016/S1470-2045(05)01767-5.
Diffuse astrocytomas of the adult cerebral hemispheres are unique among tumours in human beings in the extent to which their imaging features are related to histopathological characteristics and clinical behaviour. However, understanding is still restricted about the value of imaging features in the measurement of response and of progression in these tumours. The present approach used in clinical trials, which consists of an anatomical measurement of the enhancing tumour on MRI, has many problems, and might not be acceptable as a surrogate endpoint for survival in patients with glioblastoma who are enrolled in clinical trials. Dynamic imaging techniques, such as capillary permeability mapping, are being used in studies of new drugs that target specific molecular features of gliomas; however, the validity of these techniques has not been elucidated. Diffusion imaging can be valuable for fibre-tract mapping to assist surgical planning and might become useful in measuring early response to treatment in densely cellular tumours. Functional imaging techniques can be used to localise motor, sensory, and language-control areas before surgery. Intraoperative MRI has produced improvements in the extent of tumour resection, and molecular imaging is another technique on the horizon, which could come to have a role in clinical trials in the near future. Thus, as a rapidly expanding sphere of investigation, brain-tumour imaging is producing great excitement. The aim of these new techniques is to aid the identification of more effective treatments.
成人脑半球弥漫性星形细胞瘤在人类肿瘤中独具特色，其影像学特征与组织病理学特征及临床行为的关联程度极高。然而，对于这些肿瘤的影像学特征在评估疗效和疾病进展方面的价值，人们的认识仍较为有限。目前临床试验中采用的方法，即通过磁共振成像（MRI）对强化肿瘤进行解剖学测量，存在诸多问题，对于纳入临床试验的胶质母细胞瘤患者而言，这种方法可能无法作为生存替代终点被接受。动态成像技术，如毛细血管通透性成像，正应用于针对胶质瘤特定分子特征的新药研究中；然而，这些技术的有效性尚未得到阐明。扩散成像对于纤维束成像辅助手术规划具有重要价值，并且在测量细胞密集型肿瘤的早期治疗反应方面可能会发挥作用。功能成像技术可用于术前定位运动、感觉和语言控制区域。术中MRI已在提高肿瘤切除范围方面取得进展，分子成像则是另一项崭露头角的技术，有望在不久的将来在临床试验中发挥作用。因此，作为一个迅速扩展的研究领域，脑肿瘤成像正引发人们极大的兴趣。这些新技术的目标是帮助识别更有效的治疗方法。
