基于磁共振图像的脑胶质瘤影像学临床分型及意义  

Clinical classification of cerebral gliomas based on magnetic resonance imaging

作　　者：李文涛[1] 颜伟[1] 张军霞[1] 季晶[1] 游赣[2] 王颖毅[1] 赵春生[1] 刘宁[1] 江涛[2] 尤永平[1] 

机构地区：[1]南京医科大学第一附属医院神经外科,南京210029 [2]北京天坛医院神经外科,北京100050

出　　处：《中华神经医学杂志》2015年第12期1205-1209,共5页Chinese Journal of Neuromedicine

摘　　要：目的基于磁共振图像参数建立脑胶质瘤影像学临床分型系统并探讨其临床意义。方法南京医科大学第一附属医院和北京天坛医院神经外科自2006年1月至2013年1月收治97例幕上胶质瘤患者，回顾性分析患者术前MRI影像学资料并随访，分析与患者临床预后有关的术前MRI图像特征参数，构建脑胶质瘤影像学临床分型系统并比较不同分型患者的生存曲线。结果水肿距离病灶边缘距离≤1cm患者的生存率高于水肿距离病灶边缘距离〉1cm患者，累及脑回数=1患者的生存率高于累及脑回数〉1患者，室管膜不受累患者的生存率高于室管膜受累患者，差异均有统计学意义（P〈0．05）；构建脑胶质瘤影像学临床分型系统（亚型1：水肿距离病灶边缘距离≤1cm，累及脑回数=1；亚型2：水肿距离病灶边缘距离≤1cm，累及脑回数〉1；亚型3：水肿距离病灶边缘距离〉1cm，室管膜不受累；亚型4：水肿距离病灶边缘距离〉1cm，病变累及室管膜）；97例胶质瘤患者中亚型1-4患者（分别包括6、24、26、41例1的生存率逐渐降低，亚型1患者随访期间无死亡病例，亚型2-4患者的中位生存期分别为1116、521、336d。结论基于磁共振图像的脑胶质瘤影像学临床分型可以有效评估患者的预后，并进一步指导手术方式的标准化与规范化。Objective To establish the clinical classification system of cerebral gliomas based on MR imaging and reveal its clinical significance. Methods A retrospective analysis was performed to the preoperative MR imaging data and follow-up results of patients with cerebral gliomas confirmed by pathology between January 2006 and January 2013 in our hospitals. Preoperative MR imaging characteristic parameters related to clinical prognoses of the patients were analyzed, the clinical classification system of cerebral gliomas was established and survival curve of patients of different classifications was analyzed. Results The features fIom preoperative MR imaging, such as distance of edema edge to mass, invaded number of gyri, and ependyma, dural or cortex involvement, were correlated with clinical outcomes of glioma patients： patients with distance of edema edge to mass ≤1 cm had significantly higher survival rate than those with distance of edema edge to mass〉1 cm （P〈0.05）; patients with invaded number of gyri=l had significantly higher survival rate than those with invaded number of gyri〉 1 （P〈0.05）; patients without ependyma involvement had significantly higher survival rate than those with ependyma involvement （P〈0.05）. Four clinical subtypes with distinct prognoses based on combined analysis of edema edge to mass, invaded number of gyri and ependyma involvement or not were identified： subtype 1 （n=6, no deaths during the follow-up period, invaded gyri number=l, distance of edema edge to mass ≤ 1 cm）, subtype 2 （n=24, median survival time=1116 days, distance of edema edge to mass≤ 1 cm, invaded gyri number〉l）, subtypes 3 （n=26, median survival period=521 days, distance of edema edge to mass〉l cm and no ependyma involvement）, and subtype 4 （n=41, median survival period=336 days, distance of edema edge to mass〉l cm and no ependyma involvement）. Conclusion The clinical classification of gliomas based on MR imaging can effectively evaluate the prognoses of the patients,

关 键 词：神经胶质瘤 影像学分型 临床预后 

分 类 号：R739.41[医药卫生—肿瘤]