仿真开颅手术显示大脑浅静脉及其与脑膜瘤关系的应用价值研究  

The relationship of superficial cerebral veins with meningiomas by simulation crani＇otomy technique

作　　者：赵宏伟[1] 龚向阳[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院放射科,杭州310016

出　　处：《中华放射学杂志》2012年第1期40-44,共5页Chinese Journal of Radiology

基　　金：基金项目：浙江省“钱江人才”计划资助项目（2009R10009）

摘　　要：目的评价仿真开颅手术在显示大脑浅静脉及其与大脑凸面、矢状窦旁及大脑镰旁脑膜瘤关系中的作用。方法应用仿真开颅手术和三维对比增强MR静脉成像技术（3DCE—MRV）前瞻性地检查49例大脑凸面、矢状窦旁及大脑镰旁脑膜瘤，并进行图像后处理。采用t检验比较两种技术对大脑浅静脉显示数量的差异；评价仿真开颅手术重组图像显示脑膜瘤一大脑浅静脉关系的能力；对影响仿真开颅手术重组效果的脑膜强化与否、肿瘤大小和位置等因素采用Wilcoxon符号秩和检验进行分析。结果仿真开颅手术和3DCE．MRV显示脑膜瘤周围大脑浅静脉分别为（4．4±1．9）和（5．1±2．7）支，差异有统计学意义（t=3．131，P〈0．05）。仿真开颅手术能清楚显示脑膜瘤与大脑浅静脉关系，总平均得分为（2．5±0．7）分。有脑膜强化（12例）和无明显脑膜强化（37例）患者的主观评分分别为（1．5±0．5）、（2．8±0．3）分，无脑膜强化的图像质量明显优于有脑膜强化（Z=-3．093，P〈0．05）；小脑膜瘤组（31例）和大脑膜瘤组（18例）的主观评分分别为（2．7±0．5）、（2．2±0．9）分，小脑膜瘤组明显优于大脑膜瘤组（Z=-2．057，P〈0．05）；窦镰组（39例）和凸面组（10例）主观评分分别为（2．6±0．6）、（2．2±0．9）分，两组间差异无统计学意义（Z=-0．604，P〉0．05）。结论仿真开颅手术仅显示大脑浅静脉（SCVs），避免了大脑深静脉和头皮静脉的重叠，对大脑浅静脉评价更加准确；仿真开颅手术能较好地显示脑膜瘤与大脑浅静脉的关系，为脑膜瘤术前选择颅骨开窗位置、术中定位以及保护大脑浅静脉提供帮助。Objective To assess the value of simulation craniotomy （SC） technique in evaluation of superficial cerebral veins （SCVs） and its relationship with convexity, parasagittal and falcine meningiomas. Methods Forty-nine consecutive patients with convexity, parasagittal, and falcine meningiomas performed SC technique and three-dimensional contrast enhanced MR venography （3D CE MRV） in a prospective study. The number of SCVs （ diameter 〉 1 mm） within 2 cm around the margin of tumors detected by two techniques were compared with the paired t test. Furthermore, 49 cases were divided into groups according to the tumor largest diameter, position, and dural enhancement. The image quality of SC technique in different groups were analyzed by Wilcoxon test in order to find influence factors. Results The number of SCVs within 2 cm around the margin of tumor in SC was 4. 4 -＋ 1.9, which was significantly less than that on 3D CE MRV （ 5.1± 2. 7 ） （ t = 3.131, P 〈 0. 05 ）. The relationship between meningiomas and the SCVs was demonstrated well on SC in majority of cases with the score of image quality was 2. 5 ± 0. 7. The score of image quality of 12 patients with obvious dural enhancement was 1.5 ± 0. 5, which was significantly lower than that of 37 patients without dural enhancement （ 2. 8±0. 3 ） （ Z = - 3. 093, P 〈0. 05）. The score of image quality of 18 patients with tumor larger than 4 em in diameter （2. 2 ±0. 9）was significantly lowed than that of 31 patients with small tumors （ 2. 7 ± 0. 5 ） （ Z = - 2. 057, P 〈 0. 05 ）. The score of image quality of convexity group （n = 10） and parasagittal and falcine group （n = 39） was 2. 2 ±0. 9 and 2. 6 ± 0. 6, and there was no significant difference between different location group （ Z = - 0. 604,P 〉 0. 05 ）. Conclusions Simulation eraniotomy can exactly display SCVs avoiding the influence of deep cerebral veins and skull veins. This simple technique can provide useful information about the SCYs and their relati

关 键 词：脑膜瘤 脑静脉 磁共振成像 

分 类 号：R739.4[医药卫生—肿瘤]