Reproducibility of perfusion CT derived CBV and rCBV measurements with different slice thickness in patients with brain neoplasms

Objective:To assess inter-and intraobserver reproducibility for measuring perfusion CT derived cerebral blood volume (CBV) and relative cerebral blood volume (rCBV) with different slice thickness in patients with brain neoplasms. Meth- ods: Three independent observers who were blinded to the histopathologic diagnosis performed perfusion derived CBV and rCBV measurements with 5 mm and 10 mm slice thickness in 52 patients with various cerebral neoplasms. The results of the measurements with different slice thickness were compared. Calculation of coefficient of variation (CV), and relative paired difference of the measurements were used to determine the levels of inter- and intraobserver reproducibility. Results: The differences of CBV and rCBV measurements between different slice thickness groups were statistically significant (P < 0.05) respectively in observer 2, and were not significant in the other two observers (P > 0.05). For the same slice thickness, both the difference of CBV and rCBV measurements among the three observers were not statistically significant. Interobserver CV and relative paired difference of the measurements with 10 mm slice thickness group were slightly lower than those of 5 mm slice thickness group. Interobserver CV and relative paired difference of CBV group were slightly lower than those of rCBV group. The intraobserver differences of CBV and rCBV in 10 mm slice thickness group were statistically significant for observer 2 respectively. No other intraobserver differences of measurements were statistically significant. CV and relative paired difference of intraobserver CBV and rCBV measurements for observer 2 were significantly higher than for the other two observers. Conclusion: High reproducibility of CBV and rCBV measurements was acquired with the two different slice thickness. Suitable training may be helpful to maintain a high level of consistency for measurements.

Relationship between HER-2 overexpression and brain metastasis in esophageal cancer patients

AIM:To study if HER-2 overexpression by locally advanced esophageal cancers increase the chance of brain metastasis following esophagectomy.METHODS:We retrospectively reviewed the medical records of esophageal cancer patients who underwent esophagectomy at University of Iowa Hospitals and Clinics between 2000 and 2010.Data analyzed consisted of demographic and clinical variables.The brain metastasis tissue was assayed for HER-2 overexpression utilizing the FDA approved DAKO Hercept Test.RESULTS:One hundred and forty two patients were reviewed.Median age was 64 years(36-86 years).Eighty eight patients(62%) received neoadjuvant chemoradiotherapy.Pathological complete and partial responses were achieved in 17(19%) and 71(81%) patients.Cancer relapsed in 43/142(30%) patients.The brain was the first site of relapse in 9/43 patients(21%,95% CI:10%-36%).HER-2 immunohistochemistry testing of the brain metastasis tissue showed that 5/9(56%) cases overexpressed HER-2(3+ staining).CONCLUSION:HER-2 overexpression might be associated with increased risk of brain metastasis in esophageal cancer patients following esophagectomy.Further studies will be required to validate this observation.

Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy:Prognostic factors and survival

AIM: To identify the prognostic factors with regard to survival for patients with brain metastasis from primary tumors of the gastrointestinal tract. METHODS: Nine hundred and sixteen patients with brain metastases, treated with whole brain radiation therapy (WBRT) between January 1985 and December 2000 at the Department of Radiation Oncology, University Hospital Freiburg, were analyzed retrospectively. RESULTS: Fifty-seven patients presented with a primary tumor of the gastrointestinal tract (esophagus: n=0, stomach: n=10, colorectal: n=47). Twenty-six patients had a solitary brain metastasis, 31 patients presented with multiple brain metastases. Surgical resection was performed in 25 patients. WBRT was applied with daily fractions of 2 Gray (Gy) or 3Gy to a total dose of 50Gy or 30Gy, respectively. The interval between diagnoses of the primary tumors and brain metastases was 22.6mo vs 8.0mo for patients with primary tumors of the colon/rectum vs other primary tumors, respectively (P<0.01, log-rank). Median overall survival for all patients with brain metastases (n=916) was 3.4mo and 3.2mo for patients with gastrointestinal neoplasms. Patients with gastrointestinal primary tumors presented significantly more often with a solitary brain metastasis than patients with other primary tumors (P<0.05, log-rank). In patients with gastrointestinal neoplasms (n=57), the median overall survival was 5.8 mo for patients with solitary brain metastasis vs 2.7mo for patients with multiple brain metastases (P<0.01, log-rank). The median overall survival for patients with a Karnofsky performance status (KPS) ≥70 was 5.5mo vs 2.1mo for patients with KPS <70 (P<0.01, log-rank). At multivariate analysis (Cox Model) the performance status and the number of brain metastases were identified as independent prognostic factors for overall survival. CONCLUSION: Brain metastases occur late in the course of gastrointestinal tumors. Pretherapeutic variables like KPS and the number of brain metastases have a profound influence on treatment outcome.

Brain metastasis of hepatocellular carcinoma:A case report and review of the literature

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies in the world. It is more common in far eastern countries and relatively rare in the United States and western European countries where at autopsy it accounts for only 1-2% of malignant rumors, The disease is usually manifested in the the 6^th and 7^th decade of life. HCC is one of the highly malignant neoplasms, Extrahepatic metastases are seen in 64% of patients with HCC. The lungs, regional lymph nodes, kidney, bone marrow and adrenals are common sites of HCC metastasis^[1-3], But, metastasis to brain and skull is extremely rare. Table I shows some of the reported cases of HCC with brain metastasis. These case reports reaffirms the complex and multidisciplinary care of these patients^[4-5].

A Phase Ⅰ trial of dose escalation of topotecan combined with whole brain radiotherapy for brain metastasis in lung cancer

Objective The aim of this study was to define the maximum-tolerated dose (MTD) and observe the toxicity of escalating topotecan combined whole brain radiotherapy for brain metastasis in lung cancer.

Diffusion tensor imaging and proton magnetic resonance spectroscopy in brain tumor Correlation between structure and metabolism

Proton magnetic resonance spectroscopy and diffusion tensor imaging are non-invasive techniques used to detect metabolites and water diffusion in vivo. Previous studies have confirmed a positive correlation of individual fractional anisotropy values with N-acetylaspartate/creatine and N-acetylaspartate/choline ratios in tumors, edema, and normal white matter. This study divided the brain parenchyma into tumor, pedtumoral edema, and normal-appearing white matter according to MRI data, and analyzed the correlation of metabolites with water molecular diffusion. Results demonstrated that in normal-appearing white matter, N-acetylaspartate/creatine ratios were positively correlated with fractional anisotropy values, negatively correlated with radial diffusivities, and positively correlated with maximum eigenvalues. Maximum eigenvalues and radial diffusivities in peritumoral edema showed a negative correlation with choline, N-acetylaspartate, and creatine. Radial diffusivities in tumor demonstrated a negative correlation with choline. These data suggest that the relationship between metabolism and structure is markedly changed from normal white matter to peritumoral edema and tumor. Neural metabolism in the peritumoral edema area decreased with expanding extracellular space. The normal relationship of neural function and microstructure disappeared in the tumor region.

Parent’s Perceived Provision of Information Regarding Diagnosis to Children with Brain Tumors

Background: The aim of this study was to clarify the degree of information provision to children with brain tumors, factors influencing this provision, and the relationship between this provision and psychosocial consequences. Methods: A total of 157 parents completed a questionnaire on the degree of information provision to their children and sociodemographic and medical characteristics. Parents and their children completed subscales of the Pediatric Quality of Life Inventory (PedsQL) Cancer Module. Relevant factors were investigated using ordinal logistic regression analysis and compared with PedsQL scores by degree of information provision with adjustment for age. Results: The majority of children aged 2 - 4 years received a low level of information only in regard to medical procedure and preparation. The majority of children aged 5 - 11 years were provided information regarding disease symptoms and treatment, but not actual diagnosis. Approximately half of children aged 12 - 18 years were provided detailed information including their actual diagnosis. Older children generally received more information regarding their disease (odds ratio [OR] = 1.3 per 1 year old, P < 0.001), while children with intellectual disability received less (OR = 0.2, P = 0.006). The provision of information did not worsen scores for Procedural Anxiety, Treatment Anxiety, Worry, or Communication. Conclusions: To our knowledge, this is the first report on the degree of information provision to children with brain tumors. Parents of children with brain tumors in Japan provide information dependent on age and intellectual level. The disclosure of information to children regarding their disease might affect their trust of medical and health care professionals.

Experimental study on angiogenesis in rabbit VX_2 brain tumor using perfusion CT

Objective： To study the perfusion CT features of rabbit VX2 brain tumor with correlation to MVD and VEGF, and to validate perfusion CT for reflection of tumor angiogenesis. Methods： Rabbit VX2 brain tumor model was established by injection of 100 μL viable tumor cells （10qmL） through a 2 mm-hole 5 mm to the right of the sagittal suture and 5 mm posterior to the coronal suture bored by dental drill. MRI was performed every 2 days after seven days of implantation to evaluate the growth of the tumor. Twenty New Zealand White rabbits with tumor size over 3 mm in diameter were randomly divided into 2 groups according to the tumor growth time with those less than 3 weeks as group 1 and those more than 3 weeks as group 2, and perfusion CT were performed accordingly. CT measurements of BV, BF and PS from tumor, peritumor and contralateral normal tissue regions were obtained. After that the animals were sacrificed and 2% Evans blue （2 mL/kg） was given intravenously in 16 of these animals 1 h prior to sacrifice to detect breakdown of the blood brain barrier. VEGF and MVD were evaluated in immunohistochemical examination of the specimens. Results： Tumor had significantly higher BV, BF and PS （P=0.000） than peritumor and normal tissue region. Tumor BV, BF and MVD in group 2 were significantly higher than that in group 1 （P〈0.01）. Significant linear correlation was found between MVD and BV （t=-0.915, P=-0.000）, MVD and BF （t=0.901, P=-0.000）, and MVD and PS （t=-0.459, P=0.042）. We also found a rank correlation between PS and blue stain of tumor （rs=0.861, P=0.000）. Conclusion： Perfusion CT can distinguish tumor from peritumor and normal tissue clearly, reflect tumor angiogenesis accurately, and provide useful information for the evaluation of brain tumor.

Langerhans cell histiocytosis presenting as an isolated brain tumour:A case report

Langerhans cell histiocytosis(LCH)is a rare proliferative histiocyte disorder.It can affect any organ or system,especially the bone,skin,lung,and central nervous system(CNS).In the CNS,the hypothalamic-pituitary is predominantly affected,whereas the brain parenchyma is rarely affected.LCH occurring in the brain parenchyma can be easily confused with glioblastoma or brain metastases.Thus,multimodal imaging is useful for the differential diagnosis of these intracerebral lesions and detection of lesions in the other organs.CASE SUMMARY A 47-year-old man presented with a headache for one week and sudden syncope.Brain computed tomography(CT)and magnetic resonance imaging showed an irregularly shaped nodule with heterogeneous enhancement.On^(18)F-fluorodeoxyglucose(^(18)F-FDG)positron emission tomography/CT,a nodule with^(18)F-FDG uptake and multiple cysts in the upper lobes of both lungs were noted,which was also confirmed by high-resolution CT.Thus,the patient underwent surgical resection of the brain lesion for further examination.Postoperative pathology confirmed LCH.The patient received chemotherapy after surgery.No recurrence was observed in the brain at the 12-mo follow-up.CONCLUSION Multimodal imaging is useful for evaluating the systemic condition of LCH,developing treatment plans,and designing post-treatment strategies.

^(131)I treatment for brain metastases from differentiated thyroid carcinoma

To assess the clinical value of treatment with 131I for brain metastases from differentiated thyroid cancer (DTC), we have observed 8 cases of brain metastases from DTC who received follow-up after 131I therapy (2male, 6 female, aged 12～65 years). The results of 131I therapy were evaluated with clinical presentation, imaging scan and survival analysis. The main results are as follows. (1) All cases had been survival for 2～35 years in follow-up. (2)A space-occupying lesion in right cerebellum was reduced after taking 20.65 GBq and disappeared after 23.61 GBq,demonstrated by computed tomography. (3) The sequences and doses of 131I therapy were clearly decreased for the cases with total thyroidectomy in comparison with those with semithyroidectomy (p＜0.01). (4) The brain metastases with lung and/or bone metastasis from DTC were 75% (6/8) and it was difficult to cure these metastases at the same time. It is concluded that the postoperative treatment of 131I for brain metastases from DTC after undergoing thyroidectomy may improve clinical symptoms and life quality, reduce lesions, and prolong survival.

基于脑MRI的机器学习预测非小细胞肺癌T790M突变

目的:本研究基于脑部T_(1)C和T_(2)W MRI建立人工智能模型,预测肺癌脑转移患者在靶向治疗中的耐药性T790M突变。方法:本研究收集80例肺癌脑转移患者(2017年6月—2019年12月)的T_(1)C和T_(2)W MRI影像和临床数据进行回顾性分析(患者按照2∶1的比例分成训练集和测试集)。采用无监督k-means算法将肿瘤区域划分为高亮度区域和低亮度区域,提取不同区域的影像组学图像特征构建模型,评估每个模型的诊断效果。绘制受试者工作特征(Receiver operating characteristic,ROC)曲线,计算ROC曲线下面积(Area under curve,AUC)、特异性和敏感性作为模型评价指标,分析模型的潜在临床应用价值。结果:对T_(1)C和T_(2)W MRI和临床特征融合的统计计算表明,本研究建立的模型对T790M突变具有良好的预测能力,在训练集和测试集上的AUC分别为0.899和0.818。结论:本研究建立的计算机模型可以有效预测肺癌脑转移患者T790M突变,具有潜在的临床辅助诊断价值。

基于肺部CT生境模型预测表皮生长因子受体突变型肺腺癌脑转移

目的观察基于肺部CT生境模型预测表皮生长因子受体(EGFR)突变型肺腺癌脑转移(BM)的价值。方法回顾性分析198例EGFR突变型肺腺癌患者肺部平扫CT资料,按7∶3比例将其分为训练集(n=138)与测试集(n=60)并进一步划分BM亚组与非BM亚组。筛选训练集亚组间差异有统计学意义的变量构建逻辑回归(LR)临床模型;分别于瘤体及瘤体亚区提取特征,基于随机森林、高斯过程(GP)及支持向量机(SVM)算法构建影像组学及生境模型并筛选其中泛化能力最佳者,基于泛化能力最佳影像组学、生境模型及临床模型预测值构建LR联合模型;绘制受试者工作特征曲线,计算曲线下面积(AUC),评估各模型预测EGFR突变型肺腺癌BM的效能,以Spearman相关分析观察EGFR突变型肺腺癌Ki-67水平与生境特征的相关性。结果LR临床模型、GP影像组学模型、SVM生境模型及LR联合模型预测训练集EGFR突变型肺腺癌BM的AUC分别为0.700、0.726、0.801及0.834,在测试集分别为0.754、0.600、0.715及0.848。LR联合模型在训练集的AUC高于LR临床模型(P<0.001)、在测试集的AUC高于GP影像组学模型(P=0.010);其在训练集的效能相比GP影像组学模型及SVM生境模型均有显著正向提高[综合判别改善指数(IDI)=8.60%、8.55%,P均<0.001]。EGFR突变型肺腺癌Ki-67水平与生境图谱中的habitatmap_original_glszm_lalgle呈低度正相关(│rs│=0.201,P=0.004)。结论基于肺部CT生境模型可有效预测EGFR突变型肺腺癌BM。

肺癌脑转移患者早期死亡预测模型的构建与验证

目的构建并验证一个模型以预测肺癌脑转移(lung cancer with brain metastases,LCBM)患者确诊后三个月内死亡的风险。方法本研究纳入监测,流行病学和最终结果(Surveillance,Epidemiology and End Results,SEER)数据库内2010年1月至2015年12月期间确诊为LCBM的患者。以是否发生早期死亡为研究终点将患者分为早期死亡组和非早期死亡组。以8∶2为比例将数据分为训练集和验证集。在训练集上采用最小绝对值收缩和筛选算子(least absolute shrinkage and selection operator,LASSO)回归法筛选预测因子,并使用多因素Logistic回归构建预测模型并创建列线图。使用受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线和临床决策曲线(decision curve analysis,DCA)分别在训练集和验证集上评估模型性能。结果共纳入5035例患者,早期死亡发生率28.3%。LASSO回归筛选出13个变量,Logistic回归最终保留了13个与LCBM患者早期死亡相关的危险因素,包括年龄、从诊断到开始治疗时间、肿瘤大小、肿瘤部位、肿瘤分化程度和组织学类型、T分期、N分期、手术、放疗、化疗、肝转移和骨转移。验证集的一致性指数(concordance index,C-index)为0.84,校准曲线和DCA显示模型具有较好的预测效能和临床净效益。结论基于多因素Logistic回归构建的LCBM患者发生早期死亡的预测模型的区分度较好,能够为临床决策提供一定的帮助。

同时多层成像技术用于弥散张量成像评估脑胶质瘤

目的探讨同时多层成像(SMS)技术用于弥散张量成像(DTI)评估脑胶质瘤的价值。方法前瞻性对34例脑胶质瘤患者采集颅脑常规DTI及SMS-DTI,对比2种图像质量主观评分、信噪比(SNR)及对比度信噪比(CNR),以及基于2种图像所获全脑纤维束数及肿瘤相对各向异性分数(rFA)和平均扩散率(rMD)。结果34例中,23例为高级别、11例为低级别胶质瘤。SMS-DTI整体图像质量、显示肿瘤边缘清晰度和磁敏感伪影主观评分与常规DTI差异均无统计学意义(P均>0.05),而其SNR、CNR均低于常规DTI(P均<0.05);基于SMS-DTI所获不同病理分级脑胶质瘤患者全脑纤维束数及肿瘤rFA和rMD与常规DTI差异均无统计学意义(P均>0.05)。结论SMS技术用于DTI评估脑胶质瘤可在保证图像质量及定量分析结果准确性的前提下有效缩短采集时间。

艾迪注射液联合常规化疗对肺癌脑转移患者的临床疗效

目的观察艾迪注射液联合化疗对肺癌脑转移患者认知障碍的缓解情况。方法回顾性分析2018年6月至2020年6月在浙江省丽水市人民医院就诊的80例肺癌脑转移患者的临床资料,按照不同治疗方法分为常规化疗组和艾迪组,常规化疗组患者采用顺铂联合多西他赛的化疗方案,艾迪组在常规化疗组基础上予以艾迪注射液。观察2组患者的近期疗效、认知功能以及毒副作用,评价联合艾迪注射液治疗的有效性和安全性。结果常规化疗组患者近期有效率50%,艾迪组患者近期有效率73%,2组差异有统计学意义(χ^(2)=4.266,P=0.039)。治疗开始前,常规化疗组和艾迪组患者的蒙特利尔认知评估量表(MoCA)评分和简易智能量表(MMSE)评分差异无统计学意义。治疗后2周,与常规化疗组比较,艾迪组患者的MoCA评分和MMSE评分均增加,差异具有统计学意义(t=-3.462、-2.507,P=0.001、0.047);治疗后2周艾迪组患者的Karnofsky评分和生活质量量表(QOL)评分升高,差异具有统计学意义(t=-4.634、-4.050,P<0.01)。与常规化疗组比较,艾迪组患者骨髓抑制和眩晕情况减轻,差异具有统计学意义(χ^(2)=4.126、4.050,P=0.042、0.044),恶心呕吐等胃肠道反应和脱发情况差异无统计学意义(P>0.05)。80例患者均因本病死亡。常规化疗组患者平均生存期为(15±3)个月,艾迪组患者的中位生存期为(18±4)个月,2组差异无统计学意义(χ^(2)=17.752,P<0.01)。结论艾迪注射液联合常规化疗方案治疗肺癌脑转移患者可提升近期疗效,缓解认知障碍,减轻化疗的毒副作用,但对于患者的生存期无明显影响。

表观扩散系数鉴别肺癌脑转移瘤组织学分型及其与Ki-67增殖指数的相关性

目的探讨表观扩散系数(apparent diffusion coefficient,ADC)鉴别诊断肺癌脑转移瘤组织学分型的价值及其与Ki-67增殖指数之间的关系。材料与方法回顾性分析经手术病理证实的20例小细胞肺癌脑转移瘤和41例非小细胞肺癌脑转移瘤患者的资料,并测定其Ki-67增殖指数。在ADC图上测量肿瘤实性部分的最小ADC值(the minimum ADC,ADCmin)、平均ADC值(the mean ADC,ADCmean)及对侧正常脑白质ADC值,并计算相对ADCmin(relative ADCmin,rADCmin)及相对ADCmean(relative ADCmean,rADCmean)。对比分析二者ADC值的差异,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价ADC值的鉴别诊断价值,并计算ADC值与Ki-67增殖指数之间的相关性。结果小细胞肺癌脑转移瘤组的ADCmin、ADCmean、rADCmin及rADCmean值均小于非小细胞肺癌脑转移瘤组,组间差异均具有统计学意义(P<0.05)。各ADC值均能对小细胞肺癌脑转移瘤及非小细胞肺癌脑转移瘤进行有效鉴别,其中rADCmean值的鉴别诊断效能最好,曲线下面积(area under the curve,AUC)为0.950[95%置信区间(confidence interval,CI):0.907~0.994],最佳截断值为0.955,相应的敏感度和特异度分别为96.23%、83.87%,准确度为91.67%。小细胞肺癌脑转移瘤组的Ki-67增殖指数大于非小细胞肺癌脑转移瘤组,组间差异具有统计学意义(P<0.05)。61例肺癌脑转移瘤患者的ADCmin、ADCmean、rADCmin及rADCmean值均与Ki-67增殖指数呈不同程度的负相关(r=-0.506、r=-0.480、r=-0.569、r=-0.541)。结论ADC值可以对肺癌脑转移瘤的组织学分型进行鉴别诊断,并可以预测Ki-67增殖指数的表达水平。

基于扩散磁共振成像的脑组织微结构成像在脑肿瘤诊疗中的应用

扩散MRI(diffusion MRI,dMRI)是一种利用水分子扩散速率和方向变化产生信号对比的成像技术,成像效果主要取决于MR信号采集及后处理中所采用的定量物理模型,对于在体无创揭示脑组织与脑部疾病的微结构信息方面具有重要的应用价值。近年来,dMRI领域中不断有新成像技术涌现,诸如基于新型扩散编码的多维度扩散成像(multidimensional diffusion,MDD)、平均表观传播MRI(mean apparent propagator MRI,MAP-MRI)以及基于多隔室模型的轴突定向扩散和密度成像(neurite orientation dispersion and density imaging,NODDI)等技术。本文从信号采集和模型拟合两个方面综述了基于dMRI的多种脑组织微结构成像技术目前的发展概况,以及其在脑胶质瘤和脑转移瘤等常见脑肿瘤中的初步应用,主要包括脑肿瘤的鉴别诊断、分级评估、分子分型、疗效评估和预后预测等临床关切的问题。未来,有待进一步优化基于dMRI的脑组织微结构成像技术的成像条件,比如设置合适的b值范围及成像时间,并进一步深入研究和比较各种新型脑组织微结构成像技术在上述关键临床问题中的应用价值,以期推动基于dMRI的脑组织微结构成像技术的发展与临床应用,从微观形态学角度全面揭示脑肿瘤的特征,为脑肿瘤的早期诊断、鉴别诊断、肿瘤分级、分子分型以及预后预测提供有力依据。

弥漫性软脑膜胶质神经元肿瘤1例

患者女,21岁,头痛伴视物模糊、记忆力减退3个月,加重5天;既往体健。查体:左眼直接、间接对光反射迟钝。实验室检查:腰椎穿刺脑脊液压力330 mmH_(2)O。颅脑MRI:右侧环池及邻近脑沟内斑片状及囊状异常信号,呈T1WI等低信号、T2WI及液体衰减反转恢复序列图高信号,弥散加权成像呈等信号,增强后脑膜条片状强化,囊性病变囊壁强化;右侧颞枕叶及双侧额叶脑沟内、右侧小脑幕强化(图1A)。

脑肿瘤患者围术期深静脉血栓非药物预防的循证护理实践

目的 探讨基于最佳证据的脑肿瘤患者围术期深静脉血栓(DVT)非药物预防方法并评价其应用效果。方法 以“基于证据的持续质量改进模式”为指导,于2021年4-9月,按照证据获取、现状审查、证据引入和效果评价4个阶段将循证实践应用于脑肿瘤围术期患者,比较循证实践应用前后患者DVT发生率等指标的变化。结果 总结19条静脉血栓非药物预防证据并把证据转化为34条审查指标开展循证实践,脑肿瘤围术期DVT预防审查指标执行率及护士DVT相关知识、态度、行为水平明显提高,其中知识、行为维度差异具有统计学意义(P<0.05)。DVT发生率由10.75%降低到4.05%(P=0.020),患者知识得分由(14.00±2.14)分提高至(22.00±2.87)分(P<0.001)。结论 通过开展脑肿瘤围术期DVT非药物预防的循证实践,能有效改善临床实践环境,培养护士循证理念,提高其DVT预防知识、态度及临床措施依从性,提升患者预防知识水平,降低临床DVT发生率。