高场强术中磁共振在胶质瘤术中应用的可靠性研究

Studies on the reliability of high-field intra-operative MRI in brain glioma resection

目的评价高场强术中磁共振（iMRI）在胶质瘤手术中判断肿瘤残余的可靠性。方法选择2009年11月-2010年8月收治的胶质瘤患者131例,其中男69例,女62例,年龄779岁,平均39.6岁,均于常规导航显微镜下行肿瘤切除,切除满意后行高场强iMRI检查,将术者在显微镜下难以判断但磁共振影像上显示为肿瘤残余的部分切除并单独送病理组织学检查,而iMRI显示无残余肿瘤者术后早期复查高场强MRI,评价iMRI对残余肿瘤的检测能力。结果应用高场强iMRI可获得高质量的术中影像;剔除28例判定有肿瘤残余但因贴近功能区未继续切除的患者,结合术中切除组织病理检查与术后早期MRI复查结果,iMRI诊断残余肿瘤的敏感性为98.0%（49/50）,特异性为94.3%（50/53）,诊断正确率为96.1%（99/103）。结论 iMRI能获得高质量的术中影像,可作为脑胶质瘤术中判断肿瘤残余的一种安全可靠的手段。

Objective To evaluate the reliability of high-field intra-operative magnetic resonance imaging（iMRI） in detecting the residual tumors during glioma resection.Method One hundred and thirty-one cases of brain glioma（69 males and 62 females,aged from 7 to 79 years with mean of 39.6 years） hospitalized from Nov.2009 to Aug.2010 were involved in present study.All the patients were evaluated using magnetic resonance imaging（MRI） before the operation.The tumors were resected under conventional navigation microscope,and the high-field iMRI was used for all the patients when the operators considered the tumor was satisfactorily resected,while the residual tumor was difficult to detect under the microscope,but resected after being revealed by high-field iMRI.Histopathological examination was performed.The patients without residual tumors recieved high-field MRI scan at day 4 or 5 after operation to evaluate the accuracy of high-field iMRI during operation.Results High quality intra-operative images were obtained by using high-field iMRI.Twenty-eight cases were excluded because their residual tumors were not resected due to their location too close to functional area.Combined with the results of intra-operative histopathological examination and post-operative MRI at the early recovery stage,the sensitivity of high-field iMRI in residual tumor diagnosis was 98.0%（49/50）,the specificity was 94.3%（50/53）,and the accuracy was 96.1%（99/103）.Conclusion High-quality intra-operative imaging could be acquired by high-field iMRI,which maybe used as a safe and reliable method in detecting the residual tumors during glioma resection.