Volumetric assessment of glioma removal by intraoperative high-field magnetic resonance imaging
Volumetric assessment of glioma removal by intraoperative high-field magnetic resonance imaging
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DOI：
10.1227/01.neu.0000129694.64671.91
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发表时间：
2004-08-01
期刊：
影响因子：
4.8
通讯作者：
Fahlbusch, R
中科院分区：
文献类型：
--
作者：
Nimsky, C;Fujita, A;Fahlbusch, R
目的：探讨高场强术中磁共振成像（iMRI）的贡献，为进一步减少肿瘤体积在胶质瘤surgery.METHODS：从2002年4月至2003年6月，182例神经外科手术进行了1.5 T磁共振系统。在接受这些手术的患者中，回顾性研究了47例接受开颅手术的胶质瘤患者（14例世界卫生组织I级或11级胶质瘤，33例世界卫生组织III级或IV级胶质瘤）。肿瘤切除和体积分析的完整性进行了评估与术中成像data.Results：手术程序的影响，iMRI在36.2%的操作，手术继续切除残留的肿瘤。与第一次iMRI扫描相比，额外的进一步切除显著降低了最终肿瘤体积的百分比（6.9% +/- 10.3% vs 21.4% +/- 13.8%; P < 0.001）。低级别胶质瘤（10.3% +/- 11.5%对25.8% +/- 16.3%; P < 0.05）和高级别胶质瘤（5.4% +/- 9.9%对19.5% +/- 13.0%; P < 0.001）的最终肿瘤体积缩小也显著减少。36.2%的患者最终实现了完全切除（低级别，57.1%;高级别，27.3%）。在17例实现肿瘤完全切除的患者中，7例（41.2%）完全切除归因于iMRI后进一步肿瘤切除。我们没有遇到意外事件归因于高场iMRI，和标准的神经外科设备可以使用safety.CONCLUSION：尽管延长切除，引入高场iMRI结合功能导航并没有转化为术后赤字的风险增加。高场iMRI的使用增加了胶质瘤手术的根治性，而没有额外的发病率。
OBJECTIVE: To investigate the contribution of high-field intraoperative magnetic resonance imaging (iMRI) for further reduction of tumor volume in glioma surgery.METHODS: From April 2002 to June 2003, 182 neurosurgical procedures were performed with a 1.5-T magnetic resonance system. Among patients who underwent these procedures, 47 patients with gliomas (14 with World Health Organization Grade I or 11 glioma, and 33 with World Health Organization Grade III or IV glioma) who underwent craniotomy were investigated retrospectively. Completeness of tumor resection and volumetric analysis were assessed with intraoperative imaging data.RESULTS: Surgical procedures were influenced by iMRI in 36.2% of operations, and surgery was continued to remove residual tumor. Additional further resection significantly reduced the percentage of final tumor volume compared with first iMRI scan (6.9% +/- 10.3% versus 21.4% +/- 13.8%; P < 0.001). Percentages of final tumor volume also were significantly reduced in both low-grade (10.3% +/- 11.5% versus 25.8% +/- 16.3%; P < 0.05) and high-grade gliomas (5.4% +/- 9.9% versus 19.5% +/- 13.0%; P < 0.001). Complete resection was achieved finally in 36.2% of all patients (low-grade, 57.1 %; high-grade, 27.3%). Among the 17 patients in whom complete tumor resection was achieved, 7 complete resections (41.2%) were attributable to further tumor removal after iMRI. We did not encounter unexpected events attributable to high-field iMRI, and standard neurosurgical equipment could be used safely.CONCLUSION: Despite extended resections, introduction of high-field iMRI in conjunction with functional navigation did not translate into an increased risk of postoperative deficits. The use of high-field iMRI increased radicality in glioma surgery without additional morbidity.