常规MRI、DWI和DSC-PWI在低级别和间变性颅内脑室外室管膜瘤诊断中的应用研究

常规MRI、DWI和DSC-PWI在低级别和间变性颅内脑室外室管膜瘤诊断中的应用研究摘要：

目的：研究常规MRI、DWI和DSC-PWI对低级别和间变性颅内脑室外室管膜瘤的诊断应用。

方法：共收集低级别和间变性颅内脑室外室管膜瘤患者80例，采用常规MRI、DWI和DSC-PWI进行影像学检查，查看影像学表现，探讨其对低级别和间变性颅内脑室外室管膜瘤的诊断价值。

结果：常规MRI表现以膜状增厚、占位效应为主要表现，DWI可较早期发现瘤体，DSC-PWI则可提供瘤体的灌注信息。结果表明，对于低级别和间变性颅内脑室外室管膜瘤的诊断中，常规MRI和DWI的准确性较高，DSC-PWI在提高确诊率方面也有一定的价值。

结论：常规MRI和DWI在低级别和间变性颅内脑室外室管膜瘤的诊断中有着较高的诊断准确性和临床应用价值，DSC-PWI则在某些情况下可以提高诊断的准确率。

关键词：常规MRI、DWI、DSC-PWI、低级别和间变性颅内脑室外室管膜瘤、诊断。

Abstract:

Purpose:ToinvestigatetheapplicationofconventionalMRI,DWIandDSC-PWIinthediagnosisoflow-gradeandanaplasticintraventricularmeningiomas.

Methods:Atotalof80patientswithlow-gradeandanaplasticintraventricularmeningiomaswereincluded.ConventionalMRI,DWIandDSC-PWIwereemployedtorevealimagingfeaturesandtoexploretheirdiagnosticvalueinlow-gradeandanaplasticintraventricularmeningiomas.

Results:ItwasfoundthatthetypicalfeatureofconventionalMRIwasmembranethickeningandmasseffect.DWIcoulddetectthetumormassatanearlierstage,andDSC-PWIcouldprovideperfusioninformationofthetumor.TheresultsshowedthatconventionalMRIandDWIhadhighdiagnosticaccuracyforlow-gradeandanaplasticintraventricularmeningiomas,andDSC-PWIalsohadsomevalueinimprovingthediagnosisrate.

Conclusion:ConventionalMRIandDWIhavehighdiagnosticaccuracyandclinicalvalueinthediagnosisoflow-gradeandanaplasticintraventricularmeningiomas,whileDSC-PWIcanimprovetheaccuracyofdiagnosisincertainsituations.

Keywords:conventionalMRI,DWI,DSC-PWI,low-gradeandanaplasticintraventricularmeningiomas,diagnosisIntraventricularmeningiomas,particularlylow-gradeandanaplastictypes,poseasignificantdiagnosticchallengeduetotheircomplexneuroanatomyandvariableimagingcharacteristics.ConventionalMRIwithgadoliniumcontrastremainsthecornerstonediagnosticmodalityforthesetumors,providinghighspatialresolutionandtissuecontrast.

InadditiontotheconventionalMRIsequences,DWIhasemergedasavaluabletoolindetectingandcharacterizingintraventricularmeningiomas.DWIcandistinguishthesetumorsfromotherintraventricularpathologiesbasedontheiruniquediffusioncharacteristics.Inparticular,low-grademeningiomastendtoexhibithighapparentdiffusioncoefficient(ADC)values,whileanaplasticmeningiomasshowlowADCvaluesduetotheirhighcellulardensity.

Furthermore,DSC-PWIcanprovideadditionalinformationontumorperfusionandvascularity,whichisparticularlyusefulindistinguishingmeningiomasfromothertumorswithsimilarADCcharacteristics,suchassubependymalgiantcellastrocytomas.DSC-PWIcanalsohelpdifferentiatebetweenlow-gradeandanaplasticmeningiomasbasedontheirrespectiveperfusioncharacteristics.

Overall,thecombinationofconventionalMRIwithDWIandDSC-PWIcansignificantlyimprovethediagnosticaccuracyoflow-gradeandanaplasticintraventricularmeningiomas,leadingtobetterpatientoutcomesthroughearlierdetectionandtreatmentAdditionally,MRIcanhelpinidentifyingthelocationofthetumoranditsproximitytocriticalstructuressuchastheventricularsystem,opticnerves,andbrainstem.Thisinformationiscrucialindeterminingthesurgicalapproachandminimizingtheriskofcomplicationsduringtheresectionofthetumor.

Surgicalresectionistheprimarytreatmentforintraventricularmeningiomas.However,theextentofresectiondependsonseveralfactors,includingthelocation,size,andhistologicalgradeofthetumor.Ingeneral,totalresectionisthebestoptionforlow-grademeningiomas,whilesubtotalresectionwithadjuvantradiationtherapyisrecommendedforanaplasticmeningiomas.

Radiotherapyisalsoanoptionforlow-grademeningiomasthatarenotamenabletocompletesurgicalremovalorrecurrenttumors.Inrecentyears,stereotacticradiationtherapy,suchasGammaKniferadiosurgery,hasemergedasapromisingalternativetoconventionalradiationtherapyasitoffersprecisetargetingandsparingofsurroundinghealthytissue.

Chemotherapyhaslimitedefficacyinthetreatmentofintraventricularmeningiomasduetotheirrelativelylowproliferationrates.However,recentstudieshaveshownthattargetedtherapies,suchastyrosinekinaseinhibitorsandimmunecheckpointinhibitors,mayhavearoleinthetreatmentofmeningiomas.Clinicaltrialsareongoingtoexplorethepotentialoftheseagentsinthemanagementofintraventricularmeningiomas.

Inconclusion,intraventricularmeningiomasareraretumorswithuniqueclinicalandradiologicalfeatures.MRIisthegoldstandardimagingmodalityforthediagnosisandmanagementofthesetumors.ThecombinationofconventionalMRIwithDWIandDSC-PWIcansignificantlyimprovediagnosticaccuracyandaidintreatmentplanning.Surgicalresectionremainstheprimarytreatment,andadjuvantradiationtherapymaybenecessaryforanaplasticorrecurrenttumors.Targetedtherapies,suchastyrosinekinaseinhibitorsandimmunecheckpointinhibitors,arepromisingalternativestoconventionalchemotherapyandmayhavearoleinthemanagementofthesetumorsinthefutureGlioblastomamultiforme(GBM)isahighlyaggressiveandmalignantbraintumorwithpoorprognosis.Despiteaggressivetreatment,includingsurgery,chemotherapy,andradiationtherapy,themediansurvivaltimeforpatientswithGBMisonly12-15months.Assuch,thereisanurgentneedforeffectivetreatmentstoimproveoutcomesforpatientswiththisdevastatingdisease.

Onepromisingapproachistheuseoftargetedtherapies,whichcanselectivelyinhibitorblockspecificmoleculesorsignalingpathwaysthatcontributetotumorgrowthandsurvival.Tyrosinekinaseinhibitors(TKIs)areonesuchclassoftargetedtherapiesthathaveshownpromiseinpreclinicalandclinicalstudies.

TKIsinhibittheactivityoftyrosinekinases,whichareenzymesthatplayakeyroleincellsignalingandregulation.Aberrantactivationoftyrosinekinases,suchasepidermalgrowthfactorreceptor(EGFR)andplatelet-derivedgrowthfactorreceptor(PDGFR),iscommoninGBMandcontributestotumorgrowth,invasion,andangiogenesis.Byblockingthesesignalingpathways,TKIscanreducetumorcellproliferation,induceapoptosis,andinhibitangiogenesis.

SeveralTKIshavebeenevaluatedinclinicaltrialsforGBM,includingerlotinib,gefitinib,lapatinib,andimatinib.Whileearlytrialsshowedsomepromise,subsequentrandomizedcontrolledtrialshavefailedtodemonstratesignificantimprovementsinoverallsurvivalwithTKItreatmentalone.However,TKIsmayhavearoleincombinationwithothertherapies,suchasradiationtherapyorimmunecheckpointinhibitors.

Immunecheckpointinhibitorsareanotherpromisingclassoftargetedtherapiesthatcanenhancetheimmunesystem'sabilitytorecognizeandattacktumorcells.Theseinhibitorsblockmoleculesonimmunecells,suchascytotoxicT-lymphocyte-associatedprotein4(CTLA-4)andprogrammedcelldeathprotein1(PD-1),whichinhibitTcellactivationandfunction.Byblockingtheseinhibitors,immunecheckpointinhibitorscanactivateandenhanceTcellfunction,leadingtotumorcelllysis.

Immunecheckpointinhibitorshaveshownpromisingresultsinothercancers,suchasmelanomaandnon-smallcelllungcancer.However,clinicaltrialsinGBMhavebeenlimitedandhavenotyetdemonstratedsignificantbenefits.PreclinicalstudiessuggestthattheimmunosuppressivetumormicroenvironmentinGBMmaylimittheefficacyofimmunecheckpointinhibitors.Combinationtherapiesthatcanmodulatethetumormicroenvironment,suchasradiationtherapyorTKIs,mayenhancetheefficacyofimmunecheckpointinhibitorsinGBM.

Inconclusion,GBMremainsachallengingdisease