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Rofo 2002; 174(8): 955-964
DOI: 10.1055/s-2002-32918
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Funktionelle MR-Verfahren in der Diagnostik
intraaxialer Hirntumoren:
Perfusions- und Diffusions-Bildgebung

Functional MRI procedures in the diagnosis of brain tumors:
Perfusion- and diffusion-weighted imagingM.  Hartmann, S.  Heiland, K.  Sartor
  • 1Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg
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Publication History

Publication Date:
25 July 2002 (online)

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Zusammenfassung

Die radiologische Diagnostik intraaxialer Hirntumoren ist durch die Magnetresonanztomographie (MRT) erheblich verbessert worden, besonders nach Einführung der paramagnetischen Kontrastmittel. Mit konventionellen MR-Verfahren ist aber noch keine verlässliche Unterscheidung zwischen Gliomen, Metastasen, primären Lymphomen und tumorsimulierenden entzündlichen Erkrankungen möglich. In dieser Hinsicht vielversprechend sind neue, funktionell-dynamische MR-Verfahren, mit denen sich nicht-invasiv die zerebrale Wasserdiffusion und Mikrozirkulation erfassen lassen und die eine bessere Gewebecharakterisierung erlauben als die herkömmlichen MR-Methoden. Die Perfusions-MRT erfasst die Hämodynamik bis zur Kapillarebene. Mit Hilfe dieser neuen Methoden werden die Diagnose, die Differenzialdiagnose und postoperativ auch die Verlaufskontrolle verbessert. Eine Unterscheidung zwischen Tumor und Nicht-Tumor ist ebenso möglich wie eine zwischen niedergradigem und anaplastischem Gliom. Zudem wird die Möglichkeit einer nicht-invasiven Tumorklassifikation eröffnet, und höhergradige intraaxiale Tumoren können verlässlicher von tumorsimulierenden Herdläsionen unterschieden werden. Auch bei der Therapieplanung liefern Diffusions- und Perfusions-MRT entscheidende Zusatzinformationen, da diejenigen Tumorareale dargestellt werden können, die bei Biopsie, Operation und Bestrahlung angegangen werden müssen. In der Nachsorge erlauben die neuen Verfahren eine zuverlässige Differenzierung zwischen Therapieerfolg, Tumorrezidiv und Therapiekomplikationen, etwa der Strahlennekrose.

Abstract

Despite the increased diagnostic accuracy of contrast material enhanced MR imaging, specification and grading of brain tumors are still only approximate at best: neither morphology, nor relaxation times or contrast material enhancement reliably predict tumor histology or tumor grade. As histology and tumor grade strongly influence which therapy concept is chosen, a more precise diagnosis is mandatory. With diffusion- and perfusion-weighted MR imaging (DWI, PWI) it is now possible to obtain important information regarding the cellular matrix and the relative regional cerebral blood volume (rrCBV) of brain tumors, which cannot be obtained with standard MR techniques. These dynamic-functional imaging techniques are very useful in the preoperative diagnosis of gliomas, lymphomas, and metastases, as well as in the differentiation of these neoplastic lesions from abscesses, atypical ischemic infarctions, and tumor-like manifestations of demyelinating disease. Additionally, they appear suitable for determining glioma grade and regions of active tumor growth which should be the target of stereotactic biopsy and therapy. After therapy these techniques are helpful to better assess the tumor response to therapy, possible therapy failure and therapy complications such as radiation necrosis.

Schlüsselwörter

Hirntumoren - Perfusions-MRT - Diffusions-MRT - Differenzialdiagnose

Key words

Brain tumors - Perfusion-MRI - Diffusion-MRI - Differenzial diagnosis

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Dr. med. Marius Hartmann

Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum
Heidelberg

Im Neuenheimer Feld 400

69120 Heidelberg

Phone: + 49-6221-567566

Fax: + 49-6221-564673

Email: marius_hartmann@med.uni-heidelberg.de