MR-Bildgebung bei Gliomen

 

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Zusammenfassung

Im vorliegenden Übersichtsartikel werden die wesentlichen Entwicklungen der letzten Jahre der MR-Bildgebung bei Gliomen aufgezeigt. Schwerpunkte sind dabei die sog. RANO-Kriterien (Kriterien für das Radiology Assessment in der Neuroonkologie), die umfassende Änderungen in der Bewertung des Therapieansprechens höhergradiger Gliome mit sich brachten, sowie neue, sog. funktionelle MR-Sequenzen. Beschränkte sich die traditionelle Diagnostik bei höhergradigen Gliomen auf kontrastmittelverstärkte T1w Aufnahmen, so wurden mit Einführung der RANO-Kriterien erstmals auch T2w Sequenzen in die Beurteilung des Therapieansprechens einbezogen. Weiterhin wurde in den letzten Jahren der potenzielle Nutzen funktioneller MR-Sequenzen erforscht, die zum Teil Parameter der Tumorbiologie (z. B. Tumorvaskularisation) unmittelbar darstellen können. Nach einer kurzen Vorstellung der wesentlichen, mit Einführung der RANO-Kriterien einhergehenden Änderungen werden in diesem Übersichtsartikel die in der Praxis geläufigsten funktionellen MR-Sequenzen beschrieben: MR-Diffusion, MR-Perfusion und SWI (suszeptibilitätsgewichtete Bildgebung). Darüber hinaus wird ihr potenzieller klinischer Nutzen diskutiert. Abschließend wird ein Ausblick gegeben auf mögliche zukünftige Entwicklungen der MR-Bildgebung der Gliome. Dabei stehen die Ultrahochfeld-MRT bei 7 T (Tesla) sowie die sog. Radiomics im Zentrum der Ausführungen.

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