磁共振波谱成像引导立体定向脑内病变活检术的临床研究  

Magnetic reasonance spectroscopy-guided stereotactic biopsy for brain lesion

作　　者：卢旺盛[1] 郑奎红 邱峰[3] 贾博[1] 倪伟刚[1] 杨春兰[4] 田增民[1] 王亚明[1] 李志超[1] 孙艳杰[1] 张剑宁[1] 

机构地区：[1]海军总医院全军神经外科中心,北京100048 [2]海军总医院 影像诊断中心,北京100048 [3]海军总医院神经内科,北京100048 [4]北京工业大学生命科学与生物工程学院

出　　处：《中华外科杂志》2012年第10期898-901,共4页Chinese Journal of Surgery

基　　金：基金项目：国家自然科学基金青年科学基金资助项目（81101107）

摘　　要：目的探讨磁共振波谱成像（MRS）图像在脑内病变立体定向活检术的临床应用价值。方法2008年4月至2010年4月对126例临床诊断困难的颅内疑难病例进行脑内病变立体定向活检术，其中男性72例，女性54例；年龄10-82岁，平均年龄45岁。患者按随机数字表分成两组，行MRI引导无框架立体定向活检术（MRI组）62例，MRI＋MRS引导无框架立体定向活检术（MRS组）64例。手术运用MRI图像和三维MRS图像来进行定位，同时应用无框国产CAS—R．2型机器人来进行操作。结果立体定向活检手术无手术相关性死亡与感染。组织病理学诊断结果为脑肿瘤106例，炎性疾病6例，多发硬化和瘤样脱髓鞘病4例，神经变性疾病3例，未能获得阳性病理学诊断7例，总阳性诊断率为94．4％。其中MRS组脑内病变活检术的阳性率达98．4％（63／64），MRI组的阳性率达90．3％（56／62），两组比较差异有统计学意义（χ^2=3．92，P=0．047）。术后出现并发症4例，发生率为3．2％；分别为脑出血并发失语、癫痫、皮下血肿、消化道出血各1例，治疗后均好转。结论MRS引导立体定向脑内病变活检术，较MRI引导方法有更高的阳性率，对脑内疑难病例治疗方案的确定有一定帮助。Objective To study the clinical value of magnetic reasonance spectroscopy （MRS） image in stereotactic biopsy for brain lesion. Methods From April 2008 to April 2010,126 cases（72 male and 54 female, aged from 10 to 82 years, mean 45 years）of brain lesion which were difficult to diagnose were divided into two groups by random number table, 62 cases were executed for MRI-guided frameless stereotactic biopsy （ MRI group）, 64 cases were executed for MRI and MRS-guided frameless stereotactic biopsy（ MRS group）. Operation used MRI and Three-dimensional MRS image to locate, and used frameless CAS-R-2 robots to carry out the positioning operating. Results No surgery-related deaths and infections. Pathological diagnosis was 106 cases of brain tumors, 6 cases of inflammatory disease, 4 cases of tumor-like demyelinating disease and multiple sclerosis, 3 cases of neurodegenerative disease, 7 cases failed to obtain positive pathological diagnosis. The total rate of positive diagnosis was 94. 4%, the positive rate in MRS- guided stereotactic biopsy group was 98.4% （63/64）, the positive rate of conventional MRI-guided biopsy group was 90. 3% （56/62） , and there was statistically significant difference between the two groups（ χ^2 = 3.92,P = 0. 047 ）. Four cases presented with postoperative complications, the complication rate was 3.2% （4/126）; the complications were cerebral hemorrhage associated with aphasia, epilepsy, subcutaneous hematoma, gastrointestinal bleeding, which were improved after treatment. Conclusions MRS-guided stereotactic biopsy group has a higher positive rate than MRI-guided stereotactic biopsy group, indicating that this method can improve the positive rate of diagnosis, and thus will help to formulate treatment plan for brain lesion.

关 键 词：磁共振波谱学 立体定位技术 活组织检查 

分 类 号：R445.2[医药卫生—影像医学与核医学]