MRI动态实景渲染技术在矢状窦旁脑膜瘤Sindou分型中的应用

Application of MRI-based cinematic volume rendering technique in Sindou classification of parasagittal sinus meningioma

目的探讨基于延迟增强T1加权三维磁化强度预备梯度回波(CE-3D T1MPRAGE)的动态实景渲染技术(cVRT)在矢状窦旁脑膜瘤(PSM)术前评估中的应用价值。方法回顾性纳入经手术病理证实为单发PSM的病人108例,均完成CE-3D T1MPRAGE和MR静脉成像(MRV)检查。基于CE-3D T1MPRAGE对大脑静脉系统及PSM进行cVRT可视化处理。采用cVRT对PSM进行Sindou分型,计算其诊断准确度、敏感度、特异度。测量肿瘤邻近矢状窦窦壁及窦角,采用单因素方差分析对不同Sindou分型PSM的矢状窦角进行比较。在cVRT和MRV上观察PSM引流静脉及侧支循环的显示情况,并采用McNemar’s检验比较2种检查的显示率。结果cVRT对PSM Sindou分型的诊断准确度为89.81%,对Ⅰ型和Ⅵ型的诊断敏感度(94.88%、100%)和特异度(85.45%、91.03%)均较高。Sindou 6型中,Ⅴ型与Ⅰ型的多个矢状窦角的差异均有统计学意义(均P<0.05)。cVRT对PSM瘤周引流静脉、浅静脉吻合侧支的显示率(98.14%、91.67%)高于MRV(74.07%、78.70%),但cVRT对深静脉侧支的显示率(54.36%)低于MRV(85.18%)(均P<0.05)。结论基于CE-3D T1MPRAG的cVRT影像能够准确地对PSM Sindou进行分型,能较好地显示瘤周引流静脉、浅静脉吻合支,有助于为手术提供更准确的参考。

Objective To investigation the application value of the cinematic volume rendering technique(cVRT)based on contrast enhanced three dimensional T1 magnetization-prepared rapid gradient echo(CE-3D T1MPRAGE)in preoperative evaluation of parasagittal meningioma(PSM).Methods This retrospective study included 108 patients with solitary PSM confirmed by surgical pathology,all of whom completed CE-3D T1MPRAGE and MR venography(MRV)examinations.The cerebral venous system and PSM were visualized using cVRT based on CE-3D T1MPRAGE.The Sindou classification of PSM was performed using cVRT,and its diagnostic accuracy,sensitivity,and specificity were calculated.The sagittal sinus wall and sinus angles adjacent to the tumor were measured,and one-way ANOVA was used to compare the sagittal sinus angles of PSMs with different Sindou classifications.The display of PSM draining veins and collateral circulation on cVRT and MRV was observed,and McNemar’s test was used to compare the display rates of the two examinations.Result The diagnostic accuracy of cVRT for Sindou classification of PSM was 89.81%,with high sensitivity(94.88%,100%)and specificity(85.45%,91.03%)for typeⅠand typeⅥ,respectively.There were statistically significant differences in multiple sagittal sinus angles between typeⅤand typeⅠwithin Sindou types(P<0.05).The display rates of peritumoral draining veins and superficial venous collaterals on cVRT(98.14%,91.67%)were higher than those on MRV(74.07%,78.70%),but the display rate of deep venous collaterals on cVRT(54.36%)was lower than that on MRV(85.18%)(all P<0.05).Conclusion cVRT imaging based on CE-3D T1MPRAGE can accurately classify PSM according to Sindou,effectively displaying peritumoral draining veins and superficial venous collaterals,providing more accurate references for surgery.