Huckhagel Torge, Riedel Christian
Institut für diagnostische und interventionelle Neuroradiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Radiologie (Heidelb). 2022 Aug;62(8):683-691. doi: 10.1007/s00117-022-01014-6. Epub 2022 May 25.
Structured reporting of MRI examinations using consensus-based content categories has the potential to improve interdisciplinary communication in neuro-oncology. Therefore, the aim of this study was to determine the essential reporting categories in the imaging of gliomas from a clinical perspective within the setting of a nationwide survey of members of medical societies working in neuro-oncology.
An online questionnaire was created based on an interdisciplinary developed catalog of possible MRI reporting elements. Subsequently, specialist members of the German Societies of Neurosurgery, Radiation Oncology, Hematology and Medical Oncology, Neurology, and Neuropathology were invited to evaluate the items with regard to their clinical relevance.
A total of 171 specialists from Germany participated in the survey (81 neurosurgeons, 66 radiation therapists, and 24 other neuro-oncology experts). Number and anatomic extent of tumors in the contrast-enhanced T1 and 2D T2 sequences (98.8% vs. 97.1%) as well as newly diagnosed lesions at follow-up (T1 + contrast 98.2%; T2 94.7%) were overall most frequently considered crucial. In addition, the experts particularly rated the description of ependymal and/or leptomeningeal tumor dissemination (93.6%) and signs of mass effect including occlusive hydrocephalus and parenchymal mass shifts (> 75.0% each) as essential. Standard mention of intratumoral calcifications, hemorrhages, tumor vascular architecture, or advanced imaging modalities such as MR perfusion, diffusion, tractography, and proton spectroscopy were considered fundamental to their everyday practice by only a minority of neuro-oncology colleagues.
A referring physician-oriented minimum content standard for MRI examinations in primary brain tumor patients should include as clinically relevant core elements the exact anatomic spread of the lesion(s), including ependymal and meningeal involvement, and the pertinent signs of mass effect.
使用基于共识的内容类别对MRI检查进行结构化报告，有可能改善神经肿瘤学中的多学科交流。因此，本研究的目的是在对从事神经肿瘤学工作的医学协会成员进行全国性调查的背景下，从临床角度确定胶质瘤成像中的基本报告类别。
基于跨学科制定的可能的MRI报告要素目录创建了一份在线问卷。随后，邀请德国神经外科、放射肿瘤学、血液学和医学肿瘤学、神经病学以及神经病理学协会的专家成员评估这些项目的临床相关性。
共有171名来自德国的专家参与了调查（81名神经外科医生、66名放射治疗师和24名其他神经肿瘤学专家）。增强T1和二维T2序列中肿瘤的数量和解剖范围（分别为98.8%和97.1%）以及随访时新诊断的病变（T1加造影剂为98.2%；T2为94.7%）总体上最常被认为是关键的。此外，专家们特别将室管膜和/或软脑膜肿瘤播散的描述（93.6%）以及包括梗阻性脑积水和实质肿块移位在内的占位效应体征（各超过75.0%）视为必不可少的内容。只有少数神经肿瘤学同事认为在日常实践中，常规提及肿瘤内钙化、出血、肿瘤血管结构或诸如MR灌注、扩散、纤维束成像和质子波谱等先进成像方式是基本的。
针对原发性脑肿瘤患者的MRI检查，以转诊医生为导向的最低内容标准应将病变的确切解剖范围（包括室管膜和脑膜受累情况）以及相关的占位效应体征作为临床相关的核心要素。
