Castellano Antonella, Bailo Michele, Cicone Francesco, Carideo Luciano, Quartuccio Natale, Mortini Pietro, Falini Andrea, Cascini Giuseppe Lucio, Minniti Giuseppe
Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy.
Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy.
Cancers (Basel). 2021 Mar 3;13(5):1063. doi: 10.3390/cancers13051063.
The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current standard imaging modality for target volume delineation of gliomas. However, conventional sequences have limited capability to discriminate treatment-related changes from viable tumors, owing to the low specificity of increased blood-brain barrier permeability and peritumoral edema. Advanced physiology-based MRI techniques, such as MR spectroscopy, diffusion MRI and perfusion MRI, have been developed for the biological characterization of gliomas and may circumvent these limitations, providing additional metabolic, structural, and hemodynamic information for treatment planning and monitoring. Radionuclide imaging techniques, such as positron emission tomography (PET) with amino acid radiopharmaceuticals, are also increasingly used in the workup of primary brain tumors, and their integration in RT planning is being evaluated in specialized centers. This review focuses on the basic principles and clinical results of advanced MRI and PET imaging techniques that have promise as a complement to RT planning of gliomas.
在脑胶质瘤的放射治疗（RT）计划中，靶区勾画的准确性对于实现高肿瘤控制率、同时将治疗相关毒性降至最低至关重要。传统的磁共振成像（MRI），包括对比增强T1加权和液体衰减反转恢复（FLAIR）序列，是目前用于胶质瘤靶区体积勾画的标准成像方式。然而，由于血脑屏障通透性增加和瘤周水肿的低特异性，传统序列区分治疗相关变化与存活肿瘤的能力有限。基于先进生理学的MRI技术，如磁共振波谱、扩散MRI和灌注MRI，已被用于胶质瘤的生物学特征分析，可能会克服这些局限性，为治疗计划和监测提供额外的代谢、结构和血流动力学信息。放射性核素成像技术，如使用氨基酸放射性药物的正电子发射断层扫描（PET），也越来越多地用于原发性脑肿瘤的检查，并且其在RT计划中的整合正在专业中心进行评估。本综述重点关注先进的MRI和PET成像技术的基本原理和临床结果，这些技术有望作为胶质瘤RT计划的补充。
