Bulakbaşı Nail, Paksoy Yahya
Medical Faculty, University of Kyrenia, Sehit Yahya Bakır Street, Karakum, Mersin-10, Kyrenia, Turkish Republic of Northern Cyprus, Turkey.
Selcuk University, Konya, Turkey.
Insights Imaging. 2019 Dec 18;10(1):122. doi: 10.1186/s13244-019-0793-8.
The adult diffusely infiltrating low-grade gliomas (LGGs) are typically IDH mutant and slow-growing gliomas having moderately increased cellularity generally without mitosis, necrosis, and microvascular proliferation. Supra-total resection of LGG significantly increases the overall survival by delaying malignant transformation compared with a simple debulking so accurate MR diagnosis is crucial for treatment planning. Data from meta-analysis support the addition of diffusion and perfusion-weighted MR imaging and MR spectroscopy in the diagnosis of suspected LGG. Typically, LGG has lower cellularity (ADC), angiogenesis (rCBV), capillary permeability (K), and mitotic activity (Cho/Cr ratio) compared to high-grade glioma. The identification of 2-hydroxyglutarate by MR spectroscopy can reflect the IDH status of the tumor. The initial low ADC, high rCBV, and K values are consistent with the poor prognosis. The gradual increase in intratumoral Cho/Cr ratio and rCBV values are well correlated with tumor progression. Besides MR-based technical artifacts, which are minimized by the voxel-based assessment of data obtained by histogram analysis, the problems derived from the diversity and the analysis of imaging data should be solved by using artificial intelligence techniques. The quantitative multiparametric MR imaging of LGG can either improve the diagnostic accuracy of their differential diagnosis or assess their prognosis.
成人弥漫性浸润性低级别胶质瘤(LGG)通常为异柠檬酸脱氢酶(IDH)突变型,是生长缓慢的胶质瘤,细胞密度一般中度增加,通常无有丝分裂、坏死和微血管增殖。与单纯的肿瘤部分切除相比,LGG的超全切除通过延迟恶性转化显著提高了总生存率,因此准确的磁共振成像(MR)诊断对于治疗计划至关重要。荟萃分析的数据支持在疑似LGG的诊断中增加扩散加权成像、灌注加权成像和磁共振波谱。通常,与高级别胶质瘤相比,LGG的细胞密度(表观扩散系数[ADC])、血管生成(相对脑血容量[rCBV])、毛细血管通透性(K)和有丝分裂活性(胆碱/肌酸比值[Cho/Cr ratio])较低。通过磁共振波谱鉴定2-羟基戊二酸可以反映肿瘤的IDH状态。最初的低ADC、高rCBV和K值与预后不良一致。肿瘤内Cho/Cr比值和rCBV值的逐渐增加与肿瘤进展密切相关。除了基于MR的技术伪影(通过基于体素的直方图分析获得的数据评估可将其最小化)之外,成像数据的多样性和分析所产生的问题应通过使用人工智能技术来解决。LGG的定量多参数MR成像既可以提高其鉴别诊断的准确性,也可以评估其预后。