脑膜瘤全切除术后复发与其MRI影像学特征相关性分析

Correlation analysis of meningioma recurrence after total resection and its MRI characteristics

目的探讨高复发脑膜瘤的MRI影像学特征,以及MRI影像学特征与脑膜瘤病理分级及增殖细胞核抗原(PCNA)表达的关系,以指导临床治疗和预后评估。方法选取自1992年至2002年经我科诊治的有MRI资料的脑膜瘤病例(SimpsonⅠ级和Ⅱ级切除)77例,分为复发组与非复发组,比较两组患者的MRI影像学特征;并应用石蜡标本进行病理学检查及PCNA免疫组织化学检测,比较分析MRI特征与肿瘤复发及病理分级和PCNA标记指数(LI)的关系。结果①分叶状或蘑菇状、边界不清和位于大的静脉窦周围的脑膜瘤复发率较高,脑膜尾征与脑膜瘤的复发无关;②脑膜瘤的PCNALI值大者易复发;③内皮型脑膜瘤复发率高于其他类型脑膜瘤,病理分级级别越高越易复发。结论分叶状或蘑菇状、边界不清和位于大的静脉窦周围的脑膜瘤易复发,临床应采取综合措施,延缓或避免肿瘤复发。

Objective To study the MRI features of meningiomas with high recurrence and the relationship among MRI characteristics, pathological grades and proliferating cell nuclear antigen label index （PCNA LI） of meningiomas, to instruct the clinical treatment and prognosis prediction. Methods The clinical, MRI and pathological data of 77 patients with meningioma after total removal were studied respectively. All the patients were divided into the recurrence group and the non-recurrence group according to the follow-up results, and comparing the MR/ features between the two groups. By pathological investigation and PCNA immunohistochemistry, the relationship among MR/features, tumor recurrence, pathological grades and PCNA LI were analyzed. Results ①The meningiomas with lobular or mushroom shape, without clear interface with normal brain, and within 1 cm from sinus were prone to recur, and there was no significant correlation between dural tail sign and tumor recurrent rate;②The meningiomas with higher PCNA LI were more likely to recur than the counterpart; ③The recurrent rate of endotheliomatous meningiomas was higher than those of other subtype groups, and the recurrence was in a pathological grade dependant manner. Conclusion The meningiomas with lobular or mushroom shape, without clear margin and near sinus are prone to recur, the comprehensive approaches should be adopted to postpone or devoid recurrence.