Diffusion MRI in the early diagnosis of malignant glioma
Diffusion MRI in the early diagnosis of malignant glioma
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DOI：
10.1007/s11060-006-9273-3
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发表时间：
2007-04-01
影响因子：
3.9
通讯作者：
Fulbright, Robert K.
中科院分区：
文献类型：
--
作者：
Baehring, Joachim M.;Bi, Wenya Linda;Fulbright, Robert K.
目的 一部分恶性神经胶质瘤患者在肿块出现边缘强化和中央坏死之前就就医。这些病例中的肿瘤通常位于大脑的功能区。组织诊断仅限于立体定向活检，为准确分级提供的材料有限。我们进行这项研究是为了确定恶性胶质瘤早期的影像学特征是否有助于及时明确诊断。方法我们回顾性分析了2002年至2005年在耶鲁大学脑肿瘤中心收治的新诊断恶性胶质瘤患者。排除具有典型放射影像表现的患者。结果在89例患者中，确定了8例符合纳入标准。 5 名患者的肿瘤块内存在斑片状或小结节状增强病灶，但无中心坏死。弥散加权成像（DWI）显示所有病例中信号强度增加的区域。表观扩散系数图 (ADC) 显示相应区域的低信号强度。在成像时，对 7 名患者进行了活检，但恶性神经胶质瘤的诊断只能在 4 例肿瘤进一步生长之前才能确定。 结论 在部分病例中，恶性神经胶质瘤的早期诊断可能具有挑战性。通过 DWI 获得的信息应纳入临床决策过程。肿块病变显示水扩散减少，表明细胞结构高，提示高级神经胶质瘤。建议进行活检。然而，即使活检结果不确定，也应高度怀疑恶性胶质瘤。
Objective A subset of patients with malignant glioma comes to medical attention before their masses show rim enhancement and central necrosis. Tumors in those cases are frequently located in eloquent areas of the brain. Tissue diagnosis is limited to stereotactic biopsy providing limited material for accurate grading. We conducted this study to determine whether imaging characteristics of early stages of malignant gliomas could aid in timely definitive diagnosis.Methods We retrospectively analyzed patients with newly diagnosed malignant glioma seen at the Yale Brain Tumor Center between 2002 and 2005. Patients with typical radiographic presentation were excluded.Results Of 89 patients, eight meeting the inclusion criteria were identified. In five patients, patchy or small nodular enhancing lesions without central necrosis were present within the tumor mass. Diffusion-weighted imaging (DWI) showed areas of increased signal intensity in all cases. Apparent diffusion coefficient maps (ADC) revealed low-signal intensity in corresponding areas. At the time of imaging, biopsy was performed in seven patients but diagnosis of malignant glioma could only be established prior to further tumor growth in four cases.Conclusions The diagnosis in the early stages of malignant glioma can be challenging in a subset of cases. Information obtained through DWI should be incorporated in the clinical decision-making process. Mass lesions displaying decreased water diffusion indicating high cellularity, are suggestive of a high-grade glioma. Biopsies are recommended. However, even when biopsies are inconclusive, a strong suspicion of malignant glioma should be considered.