MRI引导脑胶质瘤立体定向活检的准确性评价

摘要

Objective:To evaluate the accuracy and clinical value of MRI-guided brain stereotactic biopsy in the management of gliomas. Methods: The diagnoses in 50 cases of brain gliomas were derived using MRI-guided stereotactic biopsy followed by open resection of the lesion.The histologic diagnoses yielded by biopsy were compared with subsequent histologic diagnosis after open tumor resection. Results: In 29 patients undergoing resection <60 days after biopsy,the biopsy diagnosis was consistent with resection diagnosis in 24 cases(83%) and led to the correct treatment in 28 cases(97%).Glioblastoma was undergraded as anaplastic astrocytoma in 4 cases.Glioblastoma was misdiagnosed as radiation necrosis in 1 case.In 21 patients undergoing resection >2 months after biopsy(mean 6.5 months),7/7(100%) biopsy diagnoses of a specific glioma grade correlated with resection diagnosis,while only 5/14(36%) biopsy diagnoses of radiation necrosis correlated with resection diagnosis. Conclusion: MRI-guided stereotactic brain biopsy specimen accurately represents the grade of the larger glioma mass sufficiently to guide subsequent therapy.Enhancement on MR may be a prognostic indicator of potential biopsy sampling error.%目的:评价MRI引导脑胶质瘤立体定向活检的准确性及临床价值.方法:回顾性分析MRI引导立体定向活检及术后病理证实的50例脑胶质瘤患者的临床、MRI及病理学资料,比较MRI 引导立体定向活检与术后病理学检查结果.结果:29例患者活检后2月内进行了手术,立体定向活检正确指导治疗28例(97%),活检与术后病理结果完全一致者24例(83%),恶性胶质瘤误诊为间变性星形细胞瘤4例,恶性胶质瘤误诊放射性脑坏死1例.21例患者于活检2个月后(平均6.5个月)进行了手术,7例活检胶质瘤分级与术后病理结果完全一致,而活检14例放射性脑坏死中仅5例(36%)符合术后病理诊断.结论:MRI引导胶质瘤立体定向活检能够充分代表整体肿瘤的病理学分级,可正确指导后续治疗,而肿瘤强化特征是活检潜在抽样误差的一个预测指标.