磁共振静脉成像在小脑幕脑膜瘤术中的指导意义

Clinical Significance of MRV in Operation of Tentorial Meningiomas

目的评价磁共振静脉成像（magnetic resonance venography,MRV）显示小脑幕脑膜瘤侵犯静脉窦的准确性,探讨MRV在小脑幕脑膜瘤术中的指导意义。方法回顾分析2009年10月-2014年4月我科经显微手术治疗的小脑幕脑膜瘤36例资料,术前均行头颅MRV,成像技术包括无需造影剂的时间飞跃法和相位对比法,以及需造影剂的对比增强法,扫描后采用最大强度投影后处理成像,部分静脉区域根据需要加做多平面重建成像,最后观察静脉窦的显示情况及其与小脑幕脑膜瘤的关系,并与术中所见结果对比。结果 36例小脑幕脑膜瘤患者中,MRV对静脉窦受侵部位的显示与术中所见完全一致;MRV诊断静脉窦受侵犯的敏感性为92.6%（25/27）,特异性为100%（9/9）,准确率为94.4%（34/36）。MRV对小脑幕脑膜瘤相关侧支静脉吻合显示的敏感性为42.9%（9/21）,特异性为86.7%（13/15）,准确率为61.1%（22/36）。结论MRV可准确地显示小脑幕脑膜瘤侵犯静脉窦的部位及程度,指导手术方案的选择,具有重要临床意义。

Objective To evaluate the accuracy of magnetic resonance venography（ MRV） for displaying encroached venous sinus by tentorial meningiomas,and to investigate the guiding significance of MRV in operation of tentorial meningiomas. Methods A retrospective review was conducted on clinical data of 36 cases of tentorial meningiomas treated at this department from October 2009 to April 2014. All the 36 patients were examined preoperatively with MRV,with imaging techniques of time of flight,phase contrast,and contrast enhancement. After scanning,the imaging was processed with the maximum intensity projection. According to needs,additional multiplanar reconstruction imaging was carried out in part of the vein area. Finally,the venous sinus condition and the relationship between sinus and tentorial meningiomas were observed and compared with intraoperative situations. Results For the visualization of the sites of all tentorial meningiomas invading the venous sinus,MRV was fully consistent with the operative findings.For the visualization of venous sinus which was invaded,the MRV sensitivity was 92. 6%（ 25 /27）,the specificity was 100%（ 9 /9）,and the consistency rate was 94. 4%（ 34 /36）. For the visualization of collateral venous anastomoses in tentorial meningiomas,the MRV sensitivity was 42. 9%（ 9 /21）,the specificity was 86. 7%（ 13 /15）,and the consistency rate was 61. 1%（ 22 /36）.Conclusions MRV can accurately display the location and extent of venous sinus which were encroached by tentorial meningiomas,guiding the choice of surgical programs. MRV has important clinical significance in operation of tentorial meningiomas.