脑干病变诊断困境：多参数磁共振成像的作用

IF 0.4 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-03-25 DOI:10.1016/j.inat.2025.102018

Xuanxuan li , Benjamin Butler , Jhanvi Sawlani , Samer Al-Ali , Michael Bowen , Markand Patel , Robert Flintham , Jane Herbert , Nigel Davies , Vijay Sawlani

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引用次数: 0

摘要

目的脑干病变是一项重大的诊断挑战。脑干的关键性质使得侵入性活检变得困难，常常产生不确定的结果。多参数磁共振成像（MRI）是标准MRI序列的有用补充，可以帮助区分肿瘤和非肿瘤病变。尽管很少有研究检验它在这方面的效用。在这里，我们介绍我们的经验，在脑干病变特征使用多参数MRI在三级神经科学中心。方法回顾性回顾2015-2020年间在我院进行的多参数MRI研究。通过标准对比增强T1和t2加权序列，动态敏感性对比（DSC） MRI，扩散加权成像（DWI），包括表观扩散系数（ADC）图和MR谱检查脑干病变特征。结果560例患者行多参数MRI检查，其中31例（5.5%）诊断为不确定脑干病变。其中，18例（58%）提供了有用的额外诊断信息，以正确区分肿瘤和炎症性病变。值得注意的病例包括低级别胶质瘤、非增强性高级别胶质瘤（转化性胶质瘤）、增强性高级别胶质瘤、比克斯塔夫脑炎和神经结节病。结论标准MRI序列结合多参数数据可以提供一种准确、无创的方法来区分炎症性和肿瘤性脑干病变，在某些情况下可能避免活检。

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Brainstem lesion diagnostic Dilemma: The role of multiparametric magnetic resonance imaging

Objectives

Brainstem lesions pose a significant diagnostic challenge. The critical nature of the brainstem renders invasive biopsy difficult, often yielding inconclusive results. Multiparametric magnetic resonance imaging (MRI) is a useful addition to standard MRI sequences and can aid in the differentiation between neoplastic and non-neoplastic lesions. Although few studies have examined its utility for this purpose. Here we present our experience in characterising brainstem lesions using multiparametric MRI at a tertiary neurosciences centre.

Methods

We retrospectively reviewed multiparametric MRI studies performed at our institution between 2015–2020. Brainstem lesion characterists on standard contrast-enhanced T1- and T2-weighted sequences, Dynamic Susceptibility Contrast (DSC) MRI, Diffusion Weighted Imaging (DWI), including Apparent Diffusion Co-efficient (ADC) maps, and MR spectroscopy were examined.

Results

Multiparametric MRI was performed on 560 patients, 31 (5.5%) of whom were assessed for indeterminate brainstem lesions. Of these, 18 (58%) provided useful additional diagnostic information to correctly differentiate neoplastic and inflammatory lesions. Cases of note include a low-grade glioma, non-enhancing high-grade glioma (transforming glioma), enhancing high-grade glioma, Bickerstaff encephalitis and neurosarcoidosis.

Conclusion

Standard MRI sequences in combination with multiparametric data can provide an accurate and non-invasive means of differentiating between inflammatory and neoplastic brainstem lesions, potentially avoiding biopsy in some cases.

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