Scola Elisa, Del Vecchio Guido, Busto Giorgio, Bianchi Andrea, Desideri Ilaria, Gadda Davide, Mancini Sara, Carlesi Edoardo, Moretti Marco, Desideri Isacco, Muscas Giovanni, Della Puppa Alessandro, Fainardi Enrico
Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy.
Radiodiagnostic Unit N. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy.
Cancers (Basel). 2023 May 30;15(11):2992. doi: 10.3390/cancers15112992.
The non-enhancing peritumoral area (NEPA) is defined as the hyperintense region in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images surrounding a brain tumor. The NEPA corresponds to different pathological processes, including vasogenic edema and infiltrative edema. The analysis of the NEPA with conventional and advanced magnetic resonance imaging (MRI) was proposed in the differential diagnosis of solid brain tumors, showing higher accuracy than MRI evaluation of the enhancing part of the tumor. In particular, MRI assessment of the NEPA was demonstrated to be a promising tool for distinguishing high-grade gliomas from primary lymphoma and brain metastases. Additionally, the MRI characteristics of the NEPA were found to correlate with prognosis and treatment response. The purpose of this narrative review was to describe MRI features of the NEPA obtained with conventional and advanced MRI techniques to better understand their potential in identifying the different characteristics of high-grade gliomas, primary lymphoma and brain metastases and in predicting clinical outcome and response to surgery and chemo-irradiation. Diffusion and perfusion techniques, such as diffusion tensor imaging (DTI), diffusional kurtosis imaging (DKI), dynamic susceptibility contrast-enhanced (DSC) perfusion imaging, dynamic contrast-enhanced (DCE) perfusion imaging, arterial spin labeling (ASL), spectroscopy and amide proton transfer (APT), were the advanced MRI procedures we reviewed.
肿瘤周围无强化区（NEPA）被定义为脑肿瘤周围T2加权成像和液体衰减反转恢复（FLAIR）成像中的高信号区域。NEPA对应于不同的病理过程，包括血管源性水肿和浸润性水肿。有人提出在实体脑肿瘤的鉴别诊断中，采用传统和先进的磁共振成像（MRI）分析NEPA，其显示出比MRI评估肿瘤强化部分更高的准确性。特别是，MRI对NEPA的评估被证明是区分高级别胶质瘤与原发性淋巴瘤和脑转移瘤的一种有前景的工具。此外，还发现NEPA的MRI特征与预后和治疗反应相关。本叙述性综述的目的是描述采用传统和先进MRI技术获得的NEPA的MRI特征，以便更好地理解它们在识别高级别胶质瘤、原发性淋巴瘤和脑转移瘤的不同特征以及预测临床结局和对手术及放化疗反应方面的潜力。扩散和灌注技术，如扩散张量成像（DTI）、扩散峰度成像（DKI）、动态磁敏感对比增强（DSC）灌注成像、动态对比增强（DCE）灌注成像、动脉自旋标记（ASL）、波谱分析和酰胺质子转移（APT），是我们所综述的先进MRI检查方法。
