磁共振成像技术和设备在垂体腺瘤诊疗中的研究进展

垂体腺瘤在颅内良性肿瘤中的发生率最高,其主要临床症状为视觉障碍和内分泌异常。磁共振成像是显示垂体腺瘤及其周围结构的首选方式;但在某些情况下,其不能反映视觉通路的微观结构损伤,也不能区分活动性肿瘤和术后组织重塑。近年来,一些磁共振成像技术和设备在垂体腺瘤的应用中展现了较多研究进展,例如弥散张量成像、超高场强磁共振、术中磁共振和分子影像等,它们在评估垂体腺瘤的诊断、治疗和预后方面具有重要作用。本文针对这些磁共振成像技术和设备在垂体腺瘤的检出、诊断及疗效评估中的应用进行简要综述。

神经导航与术中磁共振辅助手术治疗岛叶高级别胶质瘤的预后比较

目的探讨神经导航辅助和术中磁共振辅助手术治疗岛叶高级别胶质瘤的方法及预后。方法回顾分析2013年1月-2016年12月我院神经外科就诊的56例高级别胶质瘤患者的临床资料,根据手术方式分为神经导航辅助手术组(n=16)和术中磁共振辅助手术组(n=40)。导航组男性9例(56.3%),女性7例(43.7%),平均年龄(47.0±5.3)岁;磁共振辅助组男性29例(72.5%),女性11例(27.5%),平均年龄(51.0±7.1)岁;组间性别与年龄差异无统计学意义(P均<0.05)。记录两组术后肿瘤切除程度(extent of resection,EOR)、病理结果、术前KPS评分、术后放化疗等指标,并通过随访获得患者的无进展生存期(progression free survival,PFS)和总体生存期(overall survival,OS)。两组间组织病理、术前肿瘤侧别、肿瘤最大径及术前患者KPS评分均无统计学差异。结果神经导航辅助手术组全切10例(62.5%),术中磁共振辅助组全切37例(92.5%);所有患者随访12~54个月,平均随访时间28个月,术中磁共振辅助组较神经导航辅助组具有更长的PFS(39.4个月vs28.5个月,P=0.049)和OS(43.0个月vs 31.0个月,P=0.026)。COX回归分析显示手术方式(HR=0.393,P=0.024)、切除程度(HR=0.470,P=0.014)和是否应用长周期化疗方案(HR=0.410,P=0.030)为影响患者总生存时间的独立预后因素。结论术中磁共振辅助手术治疗岛叶高级别胶质瘤效果更佳,可以使患者获得较好的预后。

Evaluation of intraoperative MRI-assisted stereotactic brain tissue biopsy: a singlecenter experience in China

Background:This study aimed to investigate the value of high field-strength intraoperative magnetic resonance imaging(iMRI)-guided stereotactic biopsy in the surgery of intracranial space-occupying lesions.Methods:A total of 87 patients who underwent stereotactic biopsy of intracranial lesions in the Peking University International Hospital from March 2016 to August 2018 were retrospectively surveyed;among these,50 patients underwent MRI-guided stereotactic biopsy using the Leksell frame(iMRI group)and 37 cases received traditional stereotactic biopsy using the Leksell frame(control group).The accuracy rates and complications of the two groups were compared.Results:A 100%positive diagnosis was observed in all cases(n=50)in the iMRI group.In 4 cases,the biopsy site was clearly found to have deviated from the target point,and the biopsy was performed again.The control group had 33 cases(86.5%)with positive diagnosis.No severe complications like neural functional deficit were observed in the iMRI group,while two patients developed bleeding at the puncture site(1 case receiving surgery to remove the hematoma)in the control group.There were no deaths in either group.Conclusion:iMRI-assisted stereotactic biopsy can confirm the target position and adjust the puncture path in real time.Compared to the traditional stereotactic biopsy technique,the iMRI method has a higher positive diagnostic rate,though surgical trauma and complications have no significant difference.

高场术中核磁共振联合神经导航在胶质瘤显微手术中的应用

目的：探讨高场术中核磁共振（M RI ）联合神经导航在胶质瘤显微手术中的临床应用价值。方法回顾性分析2011年8月～2015年3月延安大学附属医院收治的胶质瘤患者80例，按照手术方式分为观察组与对照组。观察组42例患者在高场术中M RI联合神经导航下进行胶质瘤显微切除术，对照组38例患者行传统胶质瘤切除术。对两组患者围术期情况、治疗效果、术后并发症及生活质量评分进行比较。结果观察组患者的手术时间、下床活动时间、住院时间、术中出血量及术后引流量均少于对照组，差异有统计学意义（P ＜0．05）。治疗后两组生活质量恢复情况的差异无统计学意义（P＞0．05）。观察组患者术后并发症发生率为16．67％，低于对照组的44．74％，差异有统计学意义（ P ＜0.05）。结论高场术中M RI联合神经导航下进行显微切除术治疗胶质瘤定位及切除准确，疗效好，安全性高，值得临床推广应用。