1H-MRS验证荧光素钠在脑胶质瘤手术中价值的研究

发布时间：2018-05-27 01:47

本文选题：磁共振波谱 + 荧光素钠　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：多体素磁共振波谱(proton magneticreso-nancespectroscopy,1H-MRS)是一种无创性研究活体正常或病理组织代谢、生化改变以及化合物定量分析的检查方法，它能鉴别正常脑组织和病灶区域的代谢物的浓度改变进而区分肿瘤的真实边界。本研究即应用多体素磁共振波谱成像技术的特点来验证荧光素钠指导的脑胶质瘤手术切除的准确性，探索能够在较多保留神经功能的前提下，全切脑胶质瘤的手术治疗方案。方法：回顾性分析泸州医学院附属医院神经外科从2011年7月至2013年7月收治的幕上脑胶质瘤成人患者共75例，75例脑胶质瘤患者术前均进行增强MRI检查，术前进行荧光素纳皮试，术中在荧光素钠染色下严格按照荧光素钠染色范围手术切除肿瘤，若肿瘤不染色或者染色不明显的，不能按照荧光素钠染色范围切除肿瘤，则按照传统方法根据肿瘤与正常脑组织的质地差异，结合术前影像学检查经验性切除肿瘤。术中荧光素钠染色满意并严格按照染色范围切除肿瘤的患者术后进行MRS检查，并测量其术后术腔壁区（a区，术腔壁1cm以内）、肿瘤侧瘤旁脑组织区(b区，在T1WI、T2WI成像信号未见异常且无异常强化)及健侧肿瘤相应区域正常脑组织（c区）的Cho/Cr（胆碱/肌酸）比值，统计学分析比较3区Cho/Cr的差异。结果：术中肿瘤荧光素钠不染色或者染色不明显者25例，此25例脑胶质瘤病理结果为毛细胞型星形细胞瘤（WHO I级）3例，少突星形细胞瘤（WHO II级）3例，弥漫性星形细胞瘤（WHO II级）19例，术中只能经验性切除；术中肿瘤荧光素钠染色满意者50例，此50例患者病例结果为间变性少突胶质细胞瘤（WHO III级）3例，间变性星形细胞瘤（WHO III级）19例，胶质母细胞瘤（WHOIV级）28例，术中严格按照染色范围切除，术后MRS测得三区的Cho/Cr比值以ˉx±s表示，分别为a区1.72±0.35，b区0.94±0.21，，c区0.92±0.22。在荧光素钠染色满意并严格按照染色范围切除肿瘤的高级别脑胶质瘤中，先采用完全随机设计资料的方差分析比较3区的Cho/Cr比值，p0.05,差异有统计学意义，说明a、b、c3区不完全相同；再用方差分析中的q检验两两比较3区Cho/Cr比值差异，b区与c区p0.05，差异无统计学意义，说明b区与c区一样，都属于正常脑组织，a区分别与b区及c区比较，均为p0.05，差异有统计学意义，说明a区与b区及c区不同，为异常脑组织。结论：1、在低级别脑胶质瘤手术中肿瘤在荧光素钠染色下不显色或者显色不明显，不能按照染色范围切除肿瘤，故荧光素钠在低级别脑胶质瘤手术中的指导价值有限。2、在高级别胶质瘤手术中，严格按照荧光素纳的染色范围切除肿瘤，肿瘤不能够被完全切除，需扩大切除范围，但具体需要扩大切除多少，有待进一步研究。
[Abstract]:Objective: magnetic resonance spectroscopy (MRS) of multivoxel magnetic resonance spectroscopy (MRS) is a noninvasive method for the study of normal or pathological tissue metabolism, biochemical changes and quantitative analysis of compounds in vivo. It can distinguish the change of metabolite concentration between normal brain tissue and lesion area and distinguish the true boundary of tumor. In this study, the characteristics of multivoxel magnetic resonance spectroscopy were used to verify the accuracy of surgical resection of gliomas guided by sodium fluorescein. Methods: 75 adult patients with supratentorial glioma admitted from July 2011 to July 2013 in Neurosurgery Department affiliated to Luzhou Medical College were examined with enhanced MRI before operation. During the operation, the tumor was resected strictly according to the scope of fluorescein sodium staining under fluorescein sodium staining. If the tumor was not stained or stained clearly, the tumor could not be removed according to the scope of fluorescein sodium staining. According to the traditional method, according to the difference between tumor and normal brain tissue, combined with preoperative imaging examination, the tumor was resected empirically. Postoperative MRS examination was performed in patients who were satisfied with fluorescein sodium staining and had been resected strictly according to the staining range. The area of luminal wall, the area of 1cm, and the area of brain tissue adjacent to the tumor were measured. The ratio of Cho / Cr (choline / creatine) in normal brain tissue of normal brain tissue in T _ 1WI _ I _ T _ 2WI and normal brain tissue of normal brain tissue in the corresponding region of contralateral tumor was statistically analyzed and compared with the difference of Cho/Cr in the three regions. Results: tumor fluorescein sodium was not stained or stained significantly in 25 cases during the operation. The pathological results of 25 cases of glioma were as follows: 3 cases of hair cell astrocytoma, 3 cases of WHO grade I, 3 cases of oligodendroid astrocytoma, 3 cases of WHO grade II. There were 19 cases of diffuse astrocytoma with WHO grade II, which could only be resected empirically during the operation, 50 cases were satisfied with fluorescein sodium staining during the operation, and 3 cases were diagnosed as anaplastic oligodendrocytoma with WHO grade III. 19 cases of anaplastic astrocytoma with III grade and 28 cases of glioblastoma with WHOIV grade were resected strictly according to the staining range during operation. The Cho/Cr ratio of the three zones measured by MRS after operation was expressed as X 卤s, which was 1.72 卤0.35b area 0.94 卤0.21mc area 0.92 卤0.2222 respectively. In the high-grade gliomas with satisfactory fluorescein sodium staining and strictly according to the range of staining, the Cho/Cr ratio (p0.05) of the three regions was compared by ANOVA of complete random design data. The difference was statistically significant. The Q test of ANOVA was used to compare the difference of Cho/Cr ratio between region b and area c (p 0.05), which indicated that area b and area c belong to normal brain tissue, which were compared with those of area b and area c, respectively. The difference was statistically significant, indicating that area a was different from area b and area c and was abnormal brain tissue. Conclusion: in the low-grade glioma surgery, the tumor does not show color under fluorescein sodium staining, and cannot be resected according to the range of staining. Therefore, the guiding value of sodium fluorescein in low-grade glioma surgery is limited. In high-grade glioma surgery, the tumor should be resected strictly according to the range of fluorescein staining. However, the specific need to expand the number of excision, to be further studied.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.4

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