MRI引导脑胶质瘤立体定向活检的准确性评价  

Diagnositic accuracy of MRI-guided brain stereotactic biopsy in gliomas

作　　者：李映凡[1] 刘杨[2] 陈宜春[3] 胡琳[1] 

机构地区：[1]成都中医药大学附属医院放射科,四川成都610072 [2]成都市第二人民医院放射科,四川成都610017 [3]成都市龙泉驿区第一人民医院放射科,四川成都610100

出　　处：《现代肿瘤医学》2009年第8期1439-1442,共4页Journal of Modern Oncology

摘　　要：目的:评价MRI引导脑胶质瘤立体定向活检的准确性及临床价值。方法:回顾性分析MRI引导立体定向活检及术后病理证实的50例脑胶质瘤患者的临床、MRI及病理学资料,比较MRI引导立体定向活检与术后病理学检查结果。结果:29例患者活检后2月内进行了手术,立体定向活检正确指导治疗28例(97%),活检与术后病理结果完全一致者24例(83%),恶性胶质瘤误诊为间变性星形细胞瘤4例,恶性胶质瘤误诊放射性脑坏死1例。21例患者于活检2个月后(平均6.5个月)进行了手术,7例活检胶质瘤分级与术后病理结果完全一致,而活检14例放射性脑坏死中仅5例(36%)符合术后病理诊断。结论:MRI引导胶质瘤立体定向活检能够充分代表整体肿瘤的病理学分级,可正确指导后续治疗,而肿瘤强化特征是活检潜在抽样误差的一个预测指标。Objective： To evaluate the accuracy and clinical value of MRI - guided brain stereotactic biopsy in the management of gliomas. Methods： The diagnoses in 50 cases of brain giiomas were derived using MRI - guided stereotactic biopsy followed by open resection of the lesion. The histologic diagnoses yielded by biopsy were compared with subsequent histologic diagnosis after open tumor resection. Results ： In 29 patients undergoing resection 〈 60 days after biopsy,the biopsy diagnosis was consistent with resection diagnosis in 24 cases（ 83% ） and led to the correct treatment in 28 cases （97%）. Glioblastoma was undergraded as anaplastic astrocytoma in 4 cases. Glioblastoma was misdiagnosed as radiation necrosis in 1 case. In 21 patients undergoing resection 〉 2 months after biopsy（mean 6.5 months） ,7/7 （ 100% ） biopsy diagnoses of a specific glioma grade correlated with resection diagnosis ,while only 5/14 （36%） biopsy diagnoses of radiation necrosis correlated with resection diagnosis. Conclusion： MRI- guided stereotactic brain biopsy specimen accurately represents the grade of the larger glioma mass sufficiently to guide subsequent therapy. Enhancement on MR may be a prognostic indicator of potential biopsy sampling error.

关 键 词：立体定向活检 神经胶质瘤 病理学 磁共振成像 

分 类 号：R741.049[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]