CAJ | 학술논문

目的分析良性脑膜瘤的MRI表现、病理类型、病程等因素与肿瘤复发之间的关系.方法良性脑膜瘤患者218例,男58例,女160例,年龄4～ 79岁.其中31例为复发性脑膜瘤(复发组),187例为原发性脑膜瘤(原发组).所有患者均经术后病理证实.采用x2检验和秩和检验比较原发组与复发组脑膜瘤不同病理类型、MRI表现等的差异.以肿瘤是否复发为因变量,以年龄、性别、累及重要结构、病理类型等指标作为自变量,进行多元Logistic回归分析.并对累及不同重要结构的肿瘤复发时间间隔进行秩和检验.结果复发组中,30例有颅内重要结构受累或颅内外沟通瘤,比例显著高于原发组(61例),差异有统计学意义(x2 =57.672,P=0.001).复发组肿瘤位于颅底和窦旁者(30例)比例显著多于原发组(127例),差异有统计学意义(x2=10.990,P=0.001).多元Logistic回归分析显示:只有累及颅内重要结构或颅内外沟通瘤的复发风险显著升高(wald x2=31.862,优势比=3.820,P =0.001),其中硬膜窦受累的复发风险是脑动脉及颅神经受累等的3.820倍,后者又是未受累者的3.820倍.脑膜瘤病理类型、所在部位、瘤周水肿程度、肿瘤形态、体积大小在2组间差异无统计学意义.复发组累及硬膜窦和脑动脉主干的复发时间的中位数和范围分别为24(13 ～ 180)个月和126(12 ～ 187)个月,2种结构受累的复发时间差异有统计学意义(Z=2.197,P=0.028).结论位于颅底和窦旁的脑膜瘤复发更多见.颅内重要结构受累或沟通瘤显著增加良性脑膜瘤的复发风险.良性脑膜瘤累及硬膜窦的复发时间可能比累及脑动脉主干的复发更快.MRI在预测良性脑膜瘤的复发和预后中能发挥作用.
목적 분석량성뇌막류적MRI표현、병리류형、병정등인소여종류복발지간적관계.방법 량성뇌막류환자218례,남58례,녀160례,년령4～ 79세.기중31례위복발성뇌막류(복발조),187례위원발성뇌막류(원발조).소유환자균경술후병리증실.채용x2검험화질화검험비교원발조여복발조뇌막류불동병리류형、MRI표현등적차이.이종류시부복발위인변량,이년령、성별、루급중요결구、병리류형등지표작위자변량,진행다원Logistic회귀분석.병대루급불동중요결구적종류복발시간간격진행질화검험.결과 복발조중,30례유로내중요결구수루혹로내외구통류,비례현저고우원발조(61례),차이유통계학의의(x2 =57.672,P=0.001).복발조종류위우로저화두방자(30례)비례현저다우원발조(127례),차이유통계학의의(x2=10.990,P=0.001).다원Logistic회귀분석현시:지유루급로내중요결구혹로내외구통류적복발풍험현저승고(wald x2=31.862,우세비=3.820,P =0.001),기중경막두수루적복발풍험시뇌동맥급로신경수루등적3.820배,후자우시미수루자적3.820배.뇌막류병리류형、소재부위、류주수종정도、종류형태、체적대소재2조간차이무통계학의의.복발조루급경막두화뇌동맥주간적복발시간적중위수화범위분별위24(13 ～ 180)개월화126(12 ～ 187)개월,2충결구수루적복발시간차이유통계학의의(Z=2.197,P=0.028).결론 위우로저화두방적뇌막류복발경다견.로내중요결구수루혹구통류현저증가량성뇌막류적복발풍험.량성뇌막류루급경막두적복발시간가능비루급뇌동맥주간적복발경쾌.MRI재예측량성뇌막류적복발화예후중능발휘작용.
Objective To determine MR manifestations and pathologic types of benign meningiomas and their relationship with tumor recurrence.Methods There were 218 patients (160 females,58 males; age range 4-79 years) with benign meningiomas in the study,including 31 recurrent meningiomas (recurrence group)and 187 primary meningiomas (primary group).All patients were proved by postoperative pathology.Differences of pathological types and MRI manifestations between the recurrence group and the primary group were evaluated by using x2 test and rank sum test.Logistic regression analysis was performed by taking tumor recurrence as the dependent variable,and age,gender,vital structures involvement and pathologic types as independent variables.The recurrent time intervals were compared by rank sum test.Results There were 30 patients with intracranial vital structures involvement or extreintracranial communication tumors in the recurrent group,which was obviously higher than that of the primary group (61 patients).The difference was statistically significant (x2 =57.672,P =0.001).The tumors located in the skull-base and juxtasinus in the recurrent group were obviously more than those in the primary group,and difference was statistically significant (x2 =10.990,P =0.001).Multi-logistic regression analysis showed that the recurrent risk of benign meningiomas was elevated significantly only with vital structure involvement or extre-intracranial communication tumors (wald x2 =31.863,OR =3.820,P =0.001).The recurrent risk of dural sinus involvement was 3.820 times of cerebral artery trunk and cranial nerves involvement,and the risk of the latter was 3.820 times of the non-involved.There was no statistical difference between the two groups in pathology type,location,peritumoral edema,tumor morphology and tumor size.The relapse time of dural sinus involvement and cerebral artery trunk involvement in the recurrent group was 24(13 to 180) and 126(12 to 187) months,respectively.There was significant difference (Z =2.197,P =0.028).Conclusions It is more common that the recurrent benign meningiomas located in the skull base and juxtasinus.The recurrent risk significantly increases when benign meningiomas with vital intracranial structure involved or with extra-intracranial communication tumor.The relapse time of dural sinus involvement is possibly shorter than that of cerebral artery trunk involvement.MRI plays an important role in predicting tumor recurrence and prognosis of benign meningiomas.