高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

High-field intraoperative magnetic resonance imaging for glioma surgery： impact on extension of resection and surgical strategy modification

目的 评价高场强术中磁共振（iMRI）对脑胶质瘤手术切除程度及手术策略的影响.方法 解放军总医院神经外科自2009年10月至2010年6月将高场强iMRI系统应用于胶质瘤切除术患者106例,术前了解术者的切除意图（全切、次全切、大部切除）,术前1 d患者常规行MRI扫描,应用影像数据和软件计算术前肿瘤体积,术中常规使用神经导航手术,依据术者的需求采集影像.必要时行iMRI扫描计算术中残余肿瘤体积和肿瘤体积切除百分比,分析使用iMRI对肿瘤切除程度、手术策略的影响.结果 术前计划全切48例,次全切41例,大部切除17例.术中第一次扫描示42例（39.6%）完全切除,64例（60.4%）仍有残留,其中25例由于肿瘤与重要功能区或重要传导束紧邻而未作进一步切除,其余39例（36.8%）改进手术策略,标记出残留肿瘤后进一步手术,25例（23.6%）胶质瘤最终全切除,肿瘤体积切除百分比由（76.5±20.5）%提高到（94.2±8.7）%,差异有统计学意义（U=2.000,P=0.000）;最终实际全切67例,次全切25例,大部切除14例,全切率有所提高.106例患者平均肿瘤体积切除百分比由第一次扫描时的（86.3±20.2）%提高到最终扫描时的（93.6±12.4）%,差异有统计学意义（U=4.000,p=0.000）.结论 高场强iMRI的应用可显著提高脑胶质瘤的切除程度,改进手术策略.

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging （iMRI） on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons＇ intention on the extent of resection （EoR） and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 （39.6%） patients achieved complete resection, while residual tumors were depicted in 64 （60.4%）.Further tumor resections were performed in 39 patients （36.8%）, but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from （76.5±20.5）% to （94.2±8.7）%, with significant differences （U=2.000, P=0.000）; 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% （48/106） to 63.2% （67/106）： the average percentage of tumor resection volume in the second time of scan （[93.6±12.41%） was obviously increased as compared with that in the first scan （[86.3±20.21%, U=4.000, P=0.000）. Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.