术中磁共振成像联合PET／CT指导立体定向颅内病变穿刺活检的疗效观察

Stereotactic brain biopsy guided by iMRI co-registration combined with PET/CT

目的探讨术中磁共振成像（iMRI）联合PET／CT影像配准同步指导立体定向颅内病变穿刺的临床诊断效果。方法自2010年6月至2015年6月在天津医科大学总医院神经外科行立体定向活检术的患者49例。其中单纯应用iMRI引导立体定向活检17例（A组）；iMRI联合PET／CT影像配准同步指导立体定向穿刺活检32例（B组）。记录两组患者组织病理学结果和术后并发症。结果B组患者的确诊率明显高于A组患者，且差异有统计学意义（100％比82．4％，P〈0．05）；两组患者术后并发症发生率差异无统计学意义（9．3％比11．8％，P〉0．05）。结论iMRI联合PET／CT影像配准同步指导立体定向穿刺，提高确诊率，优于单纯应用iMRI引导立体定向活检技术。该技术安全有效，应在临床推广应用。

Objective To explore the clinical value of intraoperative magnetic resonance imaging （iMRI） coregistration combined with position emission tomography/computed tomography （PET/CT） in stereotactic brain biopsy. Methods Forty nine patients with intracranial lesions were operated by stereotactic biopsy from June 2010 to June 2015 in Tianjin Medical University General Hospital. Seventeen patient＇s operation was guided by iMRI only （group A）, thirty two patients＇ operation was guided by iMRI and PET/CT （group B）. The diagnosis success rate and operation related complications were compared between the two groups. Results PET/CT and iMRI were integrated successfully in all cases of group B. Fourteen patients （82. 4% ） of group A and all 32 patients （100%） of group B had final diagnosis confirmed by histopathological and immunohistochemical observation. The diagnosis success rate of group B was higher than group A （P 〈 0. 05）. There were 5 patients in total who had postoperative complication, 2 （11.8%） in group A and 3 （9.3%） in group B, but the difference was not statistically significant. Conclusions PET/CT based metabolic imaging can be automatically integrated with standard MRI guided stereotactic biopsy. Compared with iMRI only, the combined treatment improves diagnosis success rate without increasing complications; it＇s safe, and has high clinical efficacy.