CAJ | 학술논문

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(x2=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.
목적 탐토자공진파보성상(MRS)도상재뇌내병변입체정향활검술적림상응용개치.방법 2008년4월지2010년4월대126례림상진단곤난적로내의난병례진행뇌내병변입체정향활검술,기중남성72례,녀성54례；년령10 ～ 82세,평균년령45세.환자안수궤수자표분성량조,행MRI인도무광가입체정향활검술(MRI조)62례,MRI± MRS인도무광가입체정향활검술(MRS조)64례.수술운용MRI도상화삼유MRS도상래진행정위,동시응용무광국산CAS-R-2형궤기인래진행조작.결과 입체정향활검수술무수술상관성사망여감염.조직병이학진단결과위뇌종류106례,염성질병6례,다발경화화류양탈수초병4례,신경변성질병3례,미능획득양성병이학진단7례,총양성진단솔위94.4％.기중MRS조뇌내병변활검술적양성솔체98.4％ (63/64),MRI조적양성솔체90.3％(56/62),량조비교차이유통계학의의(x2=3.92,P=0.047).술후출현병발증4례,발생솔위3.2％；분별위뇌출혈병발실어、전간、피하혈종、소화도출혈각1례,치료후균호전.결론 MRS인도입체정향뇌내병변활검술,교MRI인도방법유경고적양성솔,대뇌내의난병례치료방안적학정유일정방조.
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( x2 =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.