MRI立体定向活检术在颅内病变诊断中的应用

Application of stereotactic biopsy under MRI guidance to the diagnoses of intracranial lesions(report of 23 cases)

目的探讨MRI引导下立体定向活检术在颅内病变诊断中的作用价值。方法自2009年1月至2015年3月应用立体定向系统与手术计划软件对25例颅内病变诊断不明确的患者行MRI定位下立体定向活检术。结果除1例活检阴性外,病理诊断与最后诊断(结合临床和其他检查结果)一致20例,不一致4例;最后诊断与术前MRI诊断相符合8例,不符合9例,影像未诊断6例;切除术后病理与影像相符合1例,无明确关系1例。术后6例病变内少量出血,保守治疗;1例左额叶出血30 ml,行开颅血肿清除+去骨瓣减压术。结论 MRI立体定向活检术对颅内多发、深部病变的诊断具有重要价值,其安全性较高,但仍需进一步避免脑出血的风险。

Objective To explore the vaue of MRI-guided stereotactic biopsy to the diagnoses of intracranial lesions, especially to multiple and deep lesions. Methods MRI-guided stereotactic biopsy was performed with the help of stereotactic system and surgical planning software in 25 patients with intracranial lesions from January, 2009 to March, 2015. The outcomes of the intraoperative and postoperative histological examinations helped doctors to make effective therapeutic plan. Results Of 24 cases of intracranial lesions, 9 were diagnosed as astrocytomas, 3 gliomas, 1 glioblastoma, 5 lymphomas, 1 low-grade malignant tumor, and 1 gliocyte proliferation only by the stereotactic biopsy, and 1 was diagnosed as cerebral gliomatosis, 1 lymphoma, 1 brain abscess, and 1 disseminated white-matter encephalopathy by the stereotactic biopsy combined with the clinical and other examinations. There were not positive findings by stereotactic biopsy in another patient who was suspected of having intracranial lesion before the biopsy. The biopsy complications included a small amount of cerebral hemorrhage in 6 patients who were cured by conservative treatment and 30 ml hemorrhage in the left frontal lobe in 1 patient who was cured by emergency decompressive craniotomy and evacuation of hematoma. Conclusions The stereotactic biopsy, which is of great value to the diagnoses of intracranial multiple and deep lesions, has high security, but the risk of cerebral hemorrhage caused by the stereotactic biopsy should be avoided as possible in the patients with intracranial lesions.