应用磁共振影像学参数评估凸面脑膜瘤预后的研究  

Evaluation of prognosis of convexity meningioma by using MRI imaging parameters

作　　者：高修众 汪潮湖[1] 邝欢[1] 张世超[1] 刘忆[1] 潘军[1] 漆松涛[1] 

机构地区：[1]南方医科大学南方医院神经外科,广州,510515

出　　处：《中华神经外科杂志》2016年第2期153-157,共5页Chinese Journal of Neurosurgery

基　　金：国家科技支撑计划（2014BA104B01）;广东省科技计划（20128091100463）;南方医科大学南方医院院长基金（2015C018）

摘　　要：目的 探讨凸面脑膜瘤术前MRI参数与病理分级及预后的相关性;初步建立预测脑膜瘤预后的影像学评分分级方法.方法 回顾性分析2003年1月至2006年12月南方医科大学南方医院神经外科收治的246例凸面脑膜瘤患者.术前影像学参数包括：弥散加权成像（DWI）信号强度、T1增强像、T2像蛛网膜层、T2像瘤周水肿和肿瘤形状.通过单因素分析检验肿瘤的影像学特征与临床病理分级之间的关系.采用Kaplan-Meier生存分析法、多因素Logistic回归分析评估影像学参数能否预测高级别脑膜瘤的发生.依据术前影像学参数进行评分并分级,应用Cox回归模型分析影像学评分与总体生存期（OS）和无进展生存期（PFS）之间的关系.术前影像学评分的可信度以Kappa系数检验.结果 单因素分析结果提示不同级别的凸面脑膜瘤其DWI信号强度、T1增强像、T2像蛛网膜层、T2像瘤周水肿和肿瘤形状之间的差异均有统计学意义（均P＜0.05）.多因素Logistic回归分析提示,DWI高信号是高级别脑膜瘤最主要的独立预测因子（P＜0.01）,其他依次为蛛网膜层的破坏、瘤周水肿、T1像不均匀增强以及肿瘤形状（均P＜0.01）.影像学评分分级（0～1、2～3、4～5分）与WHO病理级别（Ⅰ、Ⅱ、Ⅲ）相比,具有一定的同质性（P＜0.01）.Kaplan-Meier分析结果表明,低级别脑膜瘤患者的PFS和无进展生存率分别为（104.5±2.1）个月和86.0％;高级别脑膜瘤患者的PFS和无进展生存率分别为（27.5±2.1）个月和10.0％.Cox回归模型分析显示,年龄、WHO病理级别和术前影像学评分分组可作为影响患者预后的独立预测因子（P＜0.叭）.结论 术前影像学评分分级与病理学分级具有一定程度的一致性,可以预测凸面脑膜瘤患者的预后.对于病理学检查提示WHOⅠ级而影像学评分为2～3分的患者,可能需要更加密切的随访,在允许情况下最大程度地切除肿瘤Objectives To investigate the correlation of preoperative MRI imaging parameters and pathological grades and prognosis of convexity meningioma and to initially establish the imaging scoring method for predicting of the prognosis and biological behavior of meningiomas.Methods From January 2003 to December 2006,the preoperative imaging parameters of 246 patients underwent resection of convexity meningioma （Simpson grade Ⅰ） at the Department of Neurosurgery,Nanfang Hospital,Southern Medical University were analyzed retrospectively.The preoperative imaging parameters included the signal intensity of diffusion tensor imaging （DTI）,T1 enhanced images,subarachnoid layer on T2-weighted images,peritumoral edema on T2-weighted images and tumor shape.The relationship between imaging features of tumors and clinical pathological grades was detected by the univariate analysis.Kaplan-Meier survival analysis and multivariate logistic regression analysis were used to evaluate whether the imaging parameters could predict the occurrence of high-grade meningiomas.According to preoperative imaging parameters,the patients were graded and grouped.Cox regression model was used to analyze the relationship between the imaging scores in patients with convexity meningioma and the overall survival （OS） and progression-free survival （PFS）.The credibility of preoperative imaging scores was analyzed by the Kappa coefficient test.Results Univariate analysis results indicated that there were significant differences in diffusion tensor imaging （DWI） signal intensity,T1 enhancement images,arachnoid layer on T2 weighted imaging,peritumoral edema on T2-weighted images,and tumor shape in different grades of convexity meningiomas （all P 〈 0.05）.Multivariate logistic regression analysis indicated that DWI hyperintensity is the most important independent predictor of high-grade meningiomas （P 〈 0.01,OR,17,95% CI 5.8-47.6）,others were disruption of arachnoid layer （P 〈0.01,OR,14,95% CI 4.3-42.3）,peritumoral edema �

关 键 词：脑膜瘤 磁共振成像 弥散加权成像 预后 

分 类 号：R739.45[医药卫生—肿瘤]