应用磁共振波谱诊断及术中磁共振导航对脑脓肿的穿刺引流治疗

Diagnostic value of magnetic resonance spectroscopy and intraoperative magnetic resonance imaging in the treatment of brain abscesses

目的：通过对磁共振波谱（ MRS）诊断脑脓肿和术中磁共振穿刺引流治疗脑脓肿的回顾性分析，探讨该方法的可靠性。方法回顾分析解放军总医院2009年11月至2013年6月的41例脑脓肿患者资料，术前应用MRS分析脑脓肿的特征性峰：氨基酸峰（ AA峰，0.9 ppm ）、乙酸峰（ Ac峰，1．9 ppm）、琥珀酸盐峰（Suc峰，2．4 ppm）、丙氨酸峰（Ala峰，1．5 ppm）和乳酸峰（Lac峰）及磁共振弥散加权成像等影像学资料帮助诊断，然后30例行常规手术切除或穿刺引流治疗；有11例已形成完整包膜、经抗感染治疗不能消退的深部脑脓肿（距离皮层≥3 cm）根据导航计划设计最佳穿刺入路，术中应用1.5T术中磁共振及无框架导航系统行穿刺引流＋术中抗生素冲洗术，术后根据药敏试验结果常规应用抗生素治疗4～8周。结果41例脑脓肿均诊断正确，所有手术病例无出血，无新发并发症。应用术中磁共振穿刺引流的11例患者，10例经术中磁共振扫描证实一次穿刺成功；其中1例穿刺3次才成功，原因为其脓肿壁过于坚韧，前两次穿刺后进行术中磁共振扫描，发现穿刺针均发生侧滑而未成功，第3次调整穿刺针位置后穿刺成功，经抽吸冲洗后脓腔塌陷，抗生素治疗4～8周后，11例治愈，有1例6个月后复发。常规手术切除和穿刺引流的30例脑脓肿患者，手术均成功，抗生素治疗4～8周后，25例治愈，5例6个月后复发。结论 MRS的特征性峰在诊断脑脓肿中有独特的优势；术中磁共振及无框架导航在穿刺引流治疗脑脓肿中具有准确、安全、可靠的优点，能够在术中及时发现部分脑脓肿穿刺的偏差，并及时纠正，提高治愈率，尤其适用于脑深部单发的厚壁的脓肿。

Objective To evaluate the diagnostic value of magnetic resonance spectroscopy （ MRS） and the role of intraoperative magnetic resonance imaging （ iMRI ） in the treatment of brain abscesses by aspiration and drainage.Methods From November 2009 to June 2013, Forty-one brain abscess patients were evaluated.MRS was employed to acquire the metabolic information and assist in the differential diagnosis of brain abscesses showing lactate cytosolic amino acids （AAs） with/without succinate, acetate, alanine and glycine on MRS.Diffusion-weighted imaging （ DWI ） was also helpful.Eleven single deep-seated abscesses underwent aspiration and drainage with 1.5T iMRI and neuronavigation system.Results Forty-one brain abscesses were all diagnosed correctly.Ten single deep-seated abscesses underwent aspiration and drainage with 1.5T iMRI and neuronavigation system successfully with just one puncture.One deep-seated abscess with thick-walled was punctured thrice before achieving success because of aspirated needle sidesliping.All 11 deep-seated abscess cases were cured and were also confirmed by follow-up.None of them suffered from significant complications , such as intracranial bleeding or new neurological＆amp;nbsp;deficit.Conclusion MRS may acquire the metabolic information , confirm the presence of AAs with/without succinate, acetate, alanine and glycine and assist in the differential diagnosis of brain abscesses.iMRI system can help detect aspirated needle sidesliping and correct it in time to improve the cure rate , especially for single deep-seated brain abscess with a thick wall.