Increases in the number of brain metastases detected at frame-fixed, thin-slice MRI for gamma knife surgery planning
Increases in the number of brain metastases detected at frame-fixed, thin-slice MRI for gamma knife surgery planning
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DOI：
10.1093/neuonc/noq084
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发表时间：
2010-11-01
期刊：
影响因子：
15.9
通讯作者：
Kobayashi, Tatsuya
中科院分区：
文献类型：
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作者：
Nagai, Aiko;Shibamoto, Yuta;Kobayashi, Tatsuya
对于伽玛刀计划，2.4毫米切片的磨床是在刚性框架固定下拍摄的，因此可以看到微小的肿瘤。这项研究评估了患者转诊前常规增强MRI(层厚6+/-1 mm)和用于伽玛刀计划的增强MRI在脑转移瘤数量上的差异。至少有两位肿瘤学家计算了两幅图像上的转移数目。对于伽玛刀计划，使用1.5-T系统在0.1 mmol/kg Gd注射后获得损坏的梯度回忆回声图像。分析了1045例患者在两次MRI检查之间间隔6周或更短的时间内的图像。在1045名患者中，33.7%的患者转移数量增加，而62.3%的患者转移数量相同。在4.0%的病例中，这一数字下降，表明常规MRI过度诊断。这些比例在伽玛刀之前的间隔时间内没有显著差异。16.0%的患者由单发转移增加为多发转移。新诊断为脑膜播散者占2.3%。在计划图像上，1个、2个、3个和4个以上病变的比例分别为37.6%、19.3%、9.3%和33.8%。在结直肠癌和肝癌中，单发转移者所占比例(分别为52%和83%)明显高于其他恶性肿瘤。在大约三分之一的患者中，在薄层图像上发现了更多的转移灶。在决定脑转移瘤的治疗策略时，应牢记这一点。
For gamma knife planning, 2.4-mm-slice Mills are taken under rigid frame fixation, so tiny tumors become visible.. This study evaluated differences in the numbers of brain metastases between conventional contrast-enhanced MRI (6 +/- 1 mm slice thickness) taken before patient referral and contrast-enhanced MRI for gamma knife planning. The numbers of metastases on the 2 images were counted by at least 2 oncologists. For gamma knife planning, spoiled gradient-recalled echo images were obtained after 0.1 mmol/kg gadolinium administration using a 1.5-T system. Images from 1045 patients with an interval between the 2 MRI studies of 6 weeks or less were analyzed. Increases in the number of metastases were found in 33.7% of the 1045 patients, whereas the number was identical in 62.3%. In 4.0%, the number decreased, indicating over-diagnosis at conventional MRI. These proportions did not differ significantly by the interval before gamma knife. An increase from single to multiple metastases was found in 16.0%. Meningeal dissemination was newly diagnosed in 2.3%. On planning images, the proportions of patients with 1, 2, 3, and 4 or more lesions were 37.6%, 19.3%, 9.3%, and 33.8%, respectively. In cases of colorectal cancer and hepatoma, the proportions of patients with a single metastasis (32 of 61 [52%] and 5 of 6 [83%], respectively) were higher than that of patients with other malignancies. In about one-third of the patients, an increased number of metastases were found on the thin-slice images. This should be kept in mind when deciding the treatment strategy for brain metastases.