Michalska-Foryszewska Anna, Bujko Maciej, Kwiatkowska-Miernik Agnieszka, Ziemba Katarzyna, Sklinda Katarzyna, Walecki Jerzy, Mruk Bartosz
Radiological Diagnostics Center, The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland.
Department of Neurosurgery, The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland.
Pol J Radiol. 2024 Oct 11;89:e480-e487. doi: 10.5114/pjr/192044. eCollection 2024.
Glioblastomas are the most common and aggressive form of malignant primary brain tumors in adults. The standard treatment is surgical resection followed by radiotherapy and chemotherapy. Despite optimal treatment methods, the prognosis for patients remains poor. Preoperative determination of glioblastoma margins remains beneficial for the complete removal of the tumor mass. Radiotherapy is essential for post-surgery treatment, but radioresistance is a significant challenge contributing to high mortality rates. Advanced imaging technologies are used to analyze the changes in the peritumoral brain zone (PTZ). Consequently, they may lead to the development of novel therapeutic options, especially targeting the marginal parts of a tumor, which could improve the prognosis of glioblastoma patients. The clinical presentation of glioblastoma is heterogeneous and mostly depends on the location and size of a tumor. Glioblastomas are characterized by both intratumoral cellular heterogeneity and an extensive, diffuse infiltration into the normal tissue bordering a tumor called the PTZ. Neuroimaging techniques, such as diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), proton magnetic resonance spectroscopy (H MRS), and chemical exchange saturation transfer (CEST) are useful methods in the evaluation of the tumor infiltration and thus the resection margin.
胶质母细胞瘤是成人中最常见且侵袭性最强的原发性恶性脑肿瘤。标准治疗方法是手术切除，随后进行放疗和化疗。尽管采用了最佳治疗方法，但患者的预后仍然很差。术前确定胶质母细胞瘤的边界对于完全切除肿瘤肿块仍然有益。放疗是术后治疗的关键，但放射抗性是导致高死亡率的一个重大挑战。先进的成像技术用于分析肿瘤周围脑区（PTZ）的变化。因此，它们可能会带来新的治疗选择的发展，特别是针对肿瘤边缘部分，这可能会改善胶质母细胞瘤患者的预后。胶质母细胞瘤的临床表现具有异质性，主要取决于肿瘤的位置和大小。胶质母细胞瘤的特征在于肿瘤内细胞异质性以及广泛、弥漫性浸润到与肿瘤相邻的正常组织（即PTZ）中。神经成像技术，如扩散加权成像（DWI）、扩散张量成像（DTI）、灌注加权成像（PWI）、质子磁共振波谱（H MRS）和化学交换饱和转移（CEST），是评估肿瘤浸润以及切除边缘的有用方法。
