The highly heterogeneous and invasive nature characteristic of high-grade gliomas (HGG) has historically limited the efficacy of standard-of-care approaches, resulting in poor prognosis and treatment outcomes. Novel immunotherapies have shown remarkable potential to promote antitumoral immune responses and allow for long-term tumor remission. However, the complexity of the HGG tumor microenvironment and the dynamic immunological changes associated with immunotherapy response can limit the diagnostic utility of conventional magnetic resonance imaging (MRI) and positron emission tomography (PET) approaches. Consequently, distinguishing true tumor progression from immunotherapy-related effects often requires prolonged clinical follow-up over several months. To address this, novel quantitative MRI and PET-based approaches are being evaluated in preclinical studies and clinical trials. These advanced imaging methods target key biological features of the tumor microenvironment, including vascularity, cellularity, intratumoral habitats, tracer pharmacokinetics and immune infiltration, and can provide metrics to stratify patient response at earlier timepoints to support clinical decision making and improve treatment outcomes. This review highlights key HGG biological characteristics, describes standard-of-care and emerging therapeutic strategies, and discusses both conventional and advanced imaging methods to characterize immunotherapeutic responses.
高级别胶质瘤（HGG）具有高度异质性和侵袭性的生物学特征，这一特点长期以来限制了标准治疗方案的疗效，导致患者预后及治疗结果不佳。新型免疫疗法在促进抗肿瘤免疫反应、实现长期肿瘤缓解方面展现出显著潜力。然而，HGG肿瘤微环境的复杂性以及免疫治疗反应伴随的动态免疫学变化，可能限制传统磁共振成像（MRI）和正电子发射断层扫描（PET）方法的诊断效能。因此，区分真实肿瘤进展与免疫治疗相关效应通常需要长达数月的临床随访观察。为解决这一难题，基于定量MRI和PET的新型成像方法正在临床前研究和临床试验中进行评估。这些先进成像技术针对肿瘤微环境的关键生物学特征，包括血管分布、细胞密度、瘤内异质性区域、示踪剂药代动力学及免疫浸润情况，能够提供量化指标以在更早期阶段对患者治疗反应进行分层，从而支持临床决策并改善治疗结果。本综述重点阐述了HGG的关键生物学特征，介绍了标准治疗方案及新兴治疗策略，并讨论了用于评估免疫治疗反应的传统与先进成像方法。
肿瘤(癌症)患者之家