磁共振成像在胶质瘤中的进展:神经外科医生需要了解的内容。
Advances of MR imaging in glioma: what the neurosurgeon needs to know.
作者信息
Falk Delgado Anna
机构信息
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
出版信息
Acta Neurochir (Wien). 2025 Jun 21;167(1):174. doi: 10.1007/s00701-025-06593-6.
Glial tumors and especially glioblastoma present a major challenge in neuro-oncology due to their infiltrative growth, resistance to therapy, and poor overall survival-despite aggressive treatments such as maximal safe resection and chemoradiotherapy. These tumors typically manifest through neurological symptoms such as seizures, headaches, and signs of increased intracranial pressure, prompting urgent neuroimaging. At initial diagnosis, MRI plays a central role in differentiating true neoplasms from tumor mimics, including inflammatory or infectious conditions. Advanced techniques such as perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) enhance diagnostic specificity and may prevent unnecessary surgical intervention. In the preoperative phase, MRI contributes to surgical planning through the use of functional MRI (fMRI) and diffusion tensor imaging (DTI), enabling localization of eloquent cortex and white matter tracts. These modalities support safer resections by informing trajectory planning and risk assessment. Emerging MR techniques, including magnetic resonance spectroscopy, amide proton transfer imaging, and 2HG quantification, offer further potential in delineating tumor infiltration beyond contrast-enhancing margins. Postoperatively, MRI is important for evaluating residual tumor, detecting surgical complications, and guiding radiotherapy planning. During treatment surveillance, MRI assists in distinguishing true progression from pseudoprogression or radiation necrosis, thereby guiding decisions on additional surgery, changes in systemic therapy, or inclusion into clinical trials. The continued evolution of MRI hardware, software, and image analysis-particularly with the integration of machine learning-will be critical for supporting precision neurosurgical oncology. This review highlights how advanced MRI techniques can inform clinical decision-making at each stage of care in patients with high-grade gliomas.
胶质肿瘤,尤其是胶质母细胞瘤,由于其浸润性生长、对治疗的抵抗性以及尽管采用了如最大安全切除和放化疗等积极治疗但总体生存率仍较低,给神经肿瘤学带来了重大挑战。这些肿瘤通常通过癫痫发作、头痛和颅内压升高迹象等神经症状表现出来,从而促使进行紧急神经影像学检查。在初始诊断时,MRI在区分真正的肿瘤与肿瘤模仿物(包括炎症或感染性疾病)方面起着核心作用。灌注加权成像(PWI)和扩散加权成像(DWI)等先进技术提高了诊断特异性,并可能避免不必要的手术干预。在术前阶段,MRI通过使用功能磁共振成像(fMRI)和扩散张量成像(DTI)有助于手术规划,能够定位明确的皮层和白质束。这些模式通过告知轨迹规划和风险评估来支持更安全的切除。新兴的磁共振技术,包括磁共振波谱、酰胺质子转移成像和2-羟基戊二酸定量,在描绘肿瘤超出对比增强边缘的浸润方面具有进一步的潜力。术后,MRI对于评估残留肿瘤、检测手术并发症以及指导放疗规划很重要。在治疗监测期间,MRI有助于区分真正的进展与假性进展或放射性坏死,从而指导关于额外手术、全身治疗改变或纳入临床试验的决策。MRI硬件、软件和图像分析的持续发展——特别是机器学习的整合——对于支持精准神经外科肿瘤学至关重要。本综述强调了先进的MRI技术如何能够为高级别胶质瘤患者护理各阶段中的临床决策提供信息。
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