Halshtok Neiman Osnat, Sadetzki Siegal, Chetrit Angela, Raskin Stephen, Yaniv Gal, Hoffmann Chen
Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel.
Isr Med Assoc J. 2013 Feb;15(2):103-5.
MRI differentiation between metastases and high grade gliomas is a challenging task. Contrast enhancement and size of edema do not provide clear-cut differentiators. The differences in the properties of the peritumoral edema between these tumor types may be exploited to distinguish between them, using MRI perfusion sequences, which are capable of imaging edema in the clinical setting and may be a reliable method to make this differentiation.
To assess the ability of perfusion-weighted imaging to differentiate between high grade gliomas andbrain metastases.
During 5 months, 21 patients (age 40-85, median age 61, 16 males and 5 females) with either glioblastoma multiforme (GBM) or metastasis (pathology proven), underwent MRI for assessment of the tumor prior to surgery. Most of the scans were done at 3 Tesla. The scans included perfusion-weighted imaging sequences. Perfusion in the tumor, in the peritumoral edema and in normal tissue were assessed using Functool software. The ratios of tumor perfusion and peritumoral edema perfusion to normal tissue perfusion were calculated and compared.
Bleeding artifact precluded perfusion assessment in four patients. There was no statistically significant difference between the tumor perfusion ratios of high grade gliomas and those of metastases. The edema perfusion ratios were higher in GBM than in metastases (P = 0.007).
Perfusion-weighted imaging of peritumoral edema can help to differentiate between GBM and metastases.
磁共振成像（MRI）鉴别转移瘤和高级别胶质瘤是一项具有挑战性的任务。对比增强和水肿大小并不能提供明确的鉴别依据。利用这些肿瘤类型瘤周水肿性质的差异，通过MRI灌注序列来区分它们，该序列能够在临床环境中对水肿进行成像，可能是进行这种鉴别的可靠方法。
评估灌注加权成像区分高级别胶质瘤和脑转移瘤的能力。
在5个月期间，21例（年龄40 - 85岁，中位年龄61岁，男性16例，女性5例）患有多形性胶质母细胞瘤（GBM）或转移瘤（病理证实）的患者在手术前接受了MRI检查以评估肿瘤情况。大多数扫描在3特斯拉磁场下进行。扫描包括灌注加权成像序列。使用Functool软件评估肿瘤、瘤周水肿和正常组织中的灌注情况。计算并比较肿瘤灌注和瘤周水肿灌注与正常组织灌注的比值。
四名患者因出血伪影无法进行灌注评估。高级别胶质瘤和转移瘤的肿瘤灌注比值之间无统计学显著差异。GBM的水肿灌注比值高于转移瘤（P = 0.007）。
瘤周水肿的灌注加权成像有助于鉴别GBM和转移瘤。
