多模态磁共振成像技术在胶质母细胞瘤与脑转移瘤诊断与鉴别诊断中的研究进展

Research progress of multimodal magnetic resonance imaging in the diagnosis and differential diagnosis of glioblastoma and brain metastases

胶质母细胞瘤与脑转移瘤是两种中枢神经系统较为常见的恶性肿瘤,在常规影像序列中表现出相似的影像特征,因此无法实现准确鉴别,特别是对于缺乏病史支持的单发转移瘤,术前正确的鉴别诊断对于患者临床治疗方案的制订及预后的分析具有重要意义。多模态MRI在胶质母细胞瘤与脑转移瘤的鉴别诊断中体现出了较高的临床价值,但各MRI模型在鉴别两种病变时准确度与特异度不同,联合使用多种MRI模型可有效提高诊断效能。并且由于两种病变水肿形成机制的差异,瘤周水肿区的各参数在鉴别两种病变时诊断效能更高。本文就动态磁敏感对比增强灌注成像、动态对比增强MRI、扩散张量成像以及血氧水平依赖功能MRI等多模态MRI技术在胶质母细胞瘤与脑转移瘤鉴别诊断方面的研究进展予以综述,并扩展了一些未来可能用于解决这一临床问题的其他MRI模型,如平均表观传播扩散MRI、神经突定向扩散与密度成像以及扩散微结构成像等,以期为后续研究提供参考思路。

Glioblastoma and brain metastases are two common malignant diseases of the central nervous system. The two diseases show similar image features in conventional image sequences, and conventional image examination can not differentiate them accurately,especially for single metastasis without medical history support. Correct preoperative differential diagnosis is of great significance for the formulation of clinical treatment and the analysis of survival prognosis. Multimodal MRI has shown high clinical value in differentiating glioblastoma from brain metastases. However, the accuracy and specificity of each MRI model in differentiating the two lesions are different. The combined use of multiple MRI models can effectively improve the diagnostic efficiency. Due to the difference of edema formation mechanism between the two diseases, the parameters of peritumoral edema area have higher diagnostic efficiency in differentiating the two diseases. This paper reviews the research progress of multimodal MRI techniques such as dynamic susceptibility contrast, dynamic contrast enhanced, diffusion tensor imaging and blood oxygen level dependent functional MRI in the differential diagnosis of glioblastoma and brain metastases, and extends some other magnetic resonance models that may be used to solve this clinical problem in the future, such as a mean apparent propagator-MRI, neurite orientation dispersion and density imaging and diffusion microstructure imaging, in order to provide reference ideas for follow-up research.