Abdalla Gehad, Hammam Ahmed, Anjari Mustafa, D'Arco Dr Felice, Bisdas Dr Sotirios
Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK.
Department of Neuroradiology, Great Ormond Street Hospital for Children, London, UK.
BJR Open. 2020 Jun 23;2(1):20200009. doi: 10.1259/bjro.20200009. eCollection 2020.
Inaccurate assessment of surveillance imaging to assess response to glioma therapy may have life-changing consequences. Varied management plans including chemotherapy, radiotherapy or immunotherapy may all contribute to heterogeneous post-treatment appearances and the overlap between the morphological features of pseudoprogression, pseudoresponse and radiation necrosis can make their discrimination very challenging. Therefore, there has been a drive to develop objective strategies for post-treatment assessment of brain gliomas. This review discusses the most important of these approaches such as the RANO "Response Assessment in Neuro-Oncology", iRANO "Immunotherapy Response Assessment in Neuro-Oncology" and RAPNO "Response Assessment in Paediatric Neuro-Oncology" models. In addition to these systematic approaches for glioma surveillance, the relatively limited information provided by conventional imaging modalities alone has motivated the development of novel advanced magnetic resonance (MR) and metabolic imaging methods for further discrimination between viable tumour and treatment induced changes. Multiple clinical trials and meta-analyses have investigated the diagnostic performance of these novel techniques in the follow up of brain gliomas, including both single modality descriptive studies and comparative imaging assessment. In this manuscript, we review the literature and discuss the promises and pitfalls of frequently studied modalities in glioma surveillance imaging, including MR perfusion, MR diffusion and MR spectroscopy. In addition, we evaluate other promising MR techniques such as chemical exchange saturation transfer as well as fludeoxyglucose and non-FDG positron emission tomography techniques.
对胶质瘤治疗反应进行监测成像的不准确评估可能会产生改变人生的后果。包括化疗、放疗或免疫治疗在内的各种治疗方案都可能导致治疗后表现各异，而假性进展、假性反应和放射性坏死的形态学特征相互重叠，使得它们的鉴别极具挑战性。因此，人们一直在努力开发用于脑胶质瘤治疗后评估的客观策略。本综述讨论了其中最重要的方法，如神经肿瘤学中的RANO（“反应评估”）、神经肿瘤学中的iRANO（“免疫治疗反应评估”）和儿科神经肿瘤学中的RAPNO（“反应评估”）模型。除了这些用于胶质瘤监测的系统方法外，仅传统成像方式提供的信息相对有限，这促使人们开发新的先进磁共振（MR）和代谢成像方法，以进一步区分存活肿瘤和治疗引起的变化。多项临床试验和荟萃分析研究了这些新技术在脑胶质瘤随访中的诊断性能，包括单模态描述性研究和对比成像评估。在本手稿中，我们回顾了相关文献，并讨论了胶质瘤监测成像中经常研究的模态的前景和陷阱，包括MR灌注、MR扩散和MR波谱。此外，我们还评估了其他有前景的MR技术，如化学交换饱和转移以及氟脱氧葡萄糖和非FDG正电子发射断层扫描技术。
