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胶质瘤的 susceptibility加权成像:当前成像现状与未来方向的更新。 (注:susceptibility一般译为“敏感性”“易感性”等,这里结合语境susceptibility-weighted imaging可能是“磁敏感加权成像”,原译文表述可能不太准确,但按照要求未做修改。)

Susceptibility-Weighted Imaging of Glioma: Update on Current Imaging Status and Future Directions.

作者信息

Hsu Charlie Chia-Tsong, Watkins Trevor William, Kwan Gigi Nga Chi, Haacke E Mark

机构信息

Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

Departments of Radiology and Biomedical Engineering, Wayne State University, Detroit, MI.

出版信息

J Neuroimaging. 2016 Jul;26(4):383-90. doi: 10.1111/jon.12360. Epub 2016 May 26.

Abstract

Susceptibility-weighted imaging (SWI) provides invaluable insight into glioma pathophysiology and internal tumoral architecture. The physical contribution of intratumoral susceptibility signal (ITSS) may correspond to intralesional hemorrhage, calcification, or tumoral neovascularity. In this review, we present emerging evidence of ITSS for assessment of intratumoral calcification, grading of glioma, and factors influencing the pattern of ITSS in glioblastoma. SWI phase imaging assists in identification of intratumoral calcification that aids in narrowing the differential diagnosis. Development of intratumoral calcification posttreatment of glioma serves as an imaging marker of positive therapy response. Grading of tumors with ITSS using information attributed to microhemorrhage and neovascularity in SWI correlates with MR perfusion parameters and histologic grading of glioma and enriches preoperative prognosis. Quantitative susceptibility mapping may provide a means to discriminate subtle calcifications and hemorrhage in tumor imaging. Recent data suggest ITSS patterns in glioblastoma vary depending on tumoral volume and sublocation and correlate with degree of intratumoral necrosis and neovascularity. Increasingly, there is a recognized role of obtaining contrast-enhanced SWI (CE-SWI) for assessment of tumoral margin in high-grade glioma. Significant higher concentration of gadolinium accumulates at the border of the tumoral invasion zone as seen on the SWI sequence; this results from contrast-induced phase shift that clearly delineates the tumor margin. Lastly, absence of ITSS may aid in differentiation between high-grade glioma and primary CNS lymphoma, which typically shows absence of ITSS. We conclude that SWI and CE-SWI are indispensable tools for diagnosis, preoperative grading, posttherapy surveillance, and assessment of glioma.

摘要

磁敏感加权成像(SWI)为胶质瘤的病理生理学和肿瘤内部结构提供了宝贵的见解。肿瘤内磁敏感信号(ITSS)的物理成因可能与瘤内出血、钙化或肿瘤新生血管有关。在本综述中,我们展示了有关ITSS在评估瘤内钙化、胶质瘤分级以及影响胶质母细胞瘤中ITSS模式的因素方面的新证据。SWI相位成像有助于识别瘤内钙化,这有助于缩小鉴别诊断范围。胶质瘤治疗后瘤内钙化的出现是治疗反应良好的影像学标志。利用SWI中微出血和新生血管的信息对有ITSS的肿瘤进行分级,与磁共振灌注参数和胶质瘤的组织学分级相关,并丰富了术前预后评估。定量磁敏感图可能为在肿瘤成像中区分细微钙化和出血提供一种方法。最近的数据表明,胶质母细胞瘤中的ITSS模式因肿瘤体积和部位而异,并且与瘤内坏死程度和新生血管相关。越来越多的人认识到,获取对比增强SWI(CE-SWI)对于评估高级别胶质瘤的肿瘤边缘具有重要作用。在SWI序列上可以看到,钆在肿瘤浸润区边界处的浓度显著更高;这是由对比剂诱导的相位偏移导致的,它能清晰地勾勒出肿瘤边缘。最后,ITSS的缺失可能有助于区分高级别胶质瘤和原发性中枢神经系统淋巴瘤,后者通常显示无ITSS。我们得出结论,SWI和CE-SWI是胶质瘤诊断、术前分级、治疗后监测和评估中不可或缺的工具。

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