上矢状窦旁脑膜瘤侵犯静脉窦的三维对比增强MR静脉血管成像

Study of parasagittal meningiomas invading venous sinuses with 3D-CEMRV

目的:评价3D-CEMRV对上矢状窦旁脑膜瘤侵犯静脉窦的部位、程度、肿瘤相关静脉及侧支静脉循环通路的显示能力。方法:10例上矢状窦旁脑膜瘤的患者进行3D-CEMRV和DSA检查。两位放射学医师共同阅片取得一致意见,在原始图像、MPR像和MIP像上记录肿瘤侵犯静脉窦的部位、程度、肿瘤相关静脉及侧支静脉循环通路并和DSA及术中记录进行比较。结果:术中见上矢状窦壁侵犯1例、部分闭塞2例、完全闭塞7例。10例窦旁脑膜瘤静脉窦受侵部位3D-CEMRV所见与DSA和术中所见一致。对上矢状窦受侵犯程度的显示,3D-CEMRV和DSA所见具有高度的一致性(u=0.0000,P=1.0000),而且MIP联合MPR及原始图像优于单独应用MIP(u=-1.8796,P=0.0301)。3D-CEMRV多种后处理技术联合应用对肿瘤相关静脉和侧支循环通路的总体显示率为78.26%(36/46),DSA的总体显示率为97.83%(45/46,P=0.0016)。结论:3D-CEMRV可以对上矢状窦旁脑膜瘤侵犯静脉窦的部位、程度在术前做出准确评价,但是对肿瘤相关静脉及侧支静脉循环通路的总体显示能力仍低于DSA。

Objective： To evaluate visualization of sites, degree of invasion, tumor-related veins and collateral venous pathways with three dimensional contrast enhanced magnetic resonance venography（3D-CEMRV） in parasagittal meningiomas invading the dural sinuses. Methods： Ten patients with parasagittal meningiomas were examined preoperatively with 3D-CEMRV and intraarterial digital subtraction angiography （DSA）. The visualization of sites, degree, tumor-related veins and collateral venous pathways in meningiomas invading the dural sinuses were recorded in consensus by two radiologists. Compared with DSA and intraoperative findings, all manifestations were assessed on source images, maximum intensity projection images （MIP） and muhiplanar reconstruction images（MPR）. Results： Of the 10 patients with parasagittal meningiomas, 1 appeared invasion of sinus wall, 2 partial occlusion of sinus lumina, 7 complete occlusion of sinus lumina. The visualization of the sites of 10 parasagittal meningiomas invading the dural sinuses on 3D-CEMRV was in accordance with that of DSA and intraoperative findings. For the visualization of the degree of invasion, 3D-CEMRV images were found to be equivalent to DSA images （u= 0.0000, P=1.0000）, in the meanwhile, MIP images combined with MPR images and source images were superior to single M1P images（u=-1.8796, P=0.0301）. With multiple postprocessing display modalities of 3D-CEMRV and DSA, the rate of the visualization of tumor-related veins and collateral venous pathways was 78.26%（36/46） and 97.83%（45/46） respectively （P=0.0016）. Conclusion： With 3D-CEMRV, an exact preoperative evaluation of the sites and degree of invasion in parasagittal meningiomas invading the dural sinuses are feasible. Nevertheless, for the total visualization of tumor-related veins and collateral venous pathways, 3D-CEMRV is still inferior to DSA.