TITLE:
Multimodal Imaging to Delineate Tumor Heterogeneity in Cerebral Gliomas
AUTHORS:
Astrid Ellen Grams, Jens Gempt, Florian Ringel, Eric Soehngen, Sabrina Astner, Jürgen Schlegel, Bernhard Meyer, Claus Zimmer, Annette Förschler
KEYWORDS:
Glioma, Glioblastoma Multiforme, GBM, MR-Spectroscopy, MRS, Multimodal MRI
JOURNAL NAME:
Open Journal of Radiology,
Vol.4 No.2,
May
27,
2014
ABSTRACT:
Purpose: Magnetic resonance imaging (MRI) is
the gold standard in visualizing brain tumors and their effects on adjacent
structures. However, no reliable information concerning different tumor
components and borders between perifocal edema and infiltration areas can be
received. The aim of the study was to establish and evaluate a multimodal
imaging concept, in order to differentiate different biological tumor
components and to determine tumor borders. Materials and Methods: 12 patients
with cerebral gliomas (four low and eight high grade) received a
“morphological” MRI, a 3D MR spectroscopy and a T2* MR perfusion examination
prior to surgery. Data was evaluated by defining different tumor components,
which were entitled based upon their multimodal characteristics and histological data. Results: In
high grade gliomas different components can be differentiated, which were described as: “true
edema”, “cellular proliferation”, “vascular proliferation”, “cellular infiltration”, “tumor” and
“necrosis”. In low grade gliomas, four
different tumor components were found: “true edema”, “cellular infiltration”,
“cellular proliferation” and “tumor”. Conclusion: With the applied multimodal
imaging and a novel evaluation concept, it was
possible to detect different tumor components, which could be helpful in
detecting the optimal sites for tumor biopsy. Especially in morphological
“edema appearing” sites, this
knowledge could be important for
the adaption of tumor resection borders and the planning of radiation therapy.
Further studies
with more patients and histological correlation are needed.