CAJ | 학술논문

目的探讨脑膜瘤硬脑膜尾征的磁共振三维重建方法及其对脑膜瘤切除手术的指导意义.方法选择山东省临沂市人民医院神经外科2013年5月至2014年11月收治的23例在MRI增强T1图像上有脑膜瘤硬脑膜尾征的凸面脑膜瘤及矢状窦旁脑膜瘤患者,注射GDPA增强剂后,行磁共振3D-FLASH T1MPR序列轴位扫描,层厚为1.5 mm,应用Syngo程序行硬脑膜尾征三维重建,分别在MRI增强T1断层图像上及三维重建图像上测量硬脑膜尾征上下径及前后径,并进行比较.应用硬脑膜尾征三维重建图像设计手术切口,导航辅助下评价其优劣.结果硬脑膜尾征行MRI三维重建均能显示其全貌,肿瘤周围硬脑膜尾征多不均等,硬脑膜血管附近硬脑膜尾征延伸较远.在MRI增强T1图像上测量硬脑膜尾征上下径为2.74 ～ 7.54 cm,平均(4.67 ± 1.23)cm;三维重建图像上测量硬脑膜尾征上下径为2.75 ～7.64 cm,平均(4.70±1.25)cm,二者差异无统计学意义(P＞0.05);在MRI增强T1图像上测量硬脑膜尾征前后径为2.84～7.61 cm,平均(4.81 ±1.19)cm;三维重建图像上测量硬脑膜尾征前后径为2.88～7.74 cm,平均(4.85 ±1.22)cm,二者差异无统计学意义(P＞0.05).参照硬脑膜尾征三维重建图像设计手术切口,其优良率达91％.结论 MRI三维重建可以直观、准确地反映硬脑膜尾征的范围及形状,为脑膜瘤切口设计、硬脑膜切除范围提供依据.
목적 탐토뇌막류경뇌막미정적자공진삼유중건방법급기대뇌막류절제수술적지도의의.방법 선택산동성림기시인민의원신경외과2013년5월지2014년11월수치적23례재MRI증강T1도상상유뇌막류경뇌막미정적철면뇌막류급시상두방뇌막류환자,주사GDPA증강제후,행자공진3D-FLASH T1MPR서렬축위소묘,층후위1.5 mm,응용Syngo정서행경뇌막미정삼유중건,분별재MRI증강T1단층도상상급삼유중건도상상측량경뇌막미정상하경급전후경,병진행비교.응용경뇌막미정삼유중건도상설계수술절구,도항보조하평개기우렬.결과 경뇌막미정행MRI삼유중건균능현시기전모,종류주위경뇌막미정다불균등,경뇌막혈관부근경뇌막미정연신교원.재MRI증강T1도상상측량경뇌막미정상하경위2.74 ～ 7.54 cm,평균(4.67 ± 1.23)cm;삼유중건도상상측량경뇌막미정상하경위2.75 ～7.64 cm,평균(4.70±1.25)cm,이자차이무통계학의의(P＞0.05);재MRI증강T1도상상측량경뇌막미정전후경위2.84～7.61 cm,평균(4.81 ±1.19)cm;삼유중건도상상측량경뇌막미정전후경위2.88～7.74 cm,평균(4.85 ±1.22)cm,이자차이무통계학의의(P＞0.05).삼조경뇌막미정삼유중건도상설계수술절구,기우량솔체91％.결론 MRI삼유중건가이직관、준학지반영경뇌막미정적범위급형상,위뇌막류절구설계、경뇌막절제범위제공의거.
Objective To investigate the methods of MRI 3D reconstruction of dural tail sign of meningiomas and its guiding significance for meningioma resection.Methods Twenty-three patients with convexity meningioma and parasagittal meningioma with dural tail sign on contrast-enhanced MRI-T1 images treated at the Department of Neurosurgery of Linyi People' s Hospital,Shandong Province were selected from May 2013 to November 2014.After injection of gadolinium diethylene-trianmine pentaacetic acid (DTPA) enhancer,MR 3D-FLASH TIMPR sequence axial scanning was performed,and the layer thickness was 1.5 mm.the syngo program was used to perform the 3D reconstruction of dural tail sign.The vertical diameter and anteroposterior diameter of meningioma dural tail sign on the enhanced T1 MRI tomographic images and 3D reconstruction images were measured and compared.The surgical incisions were designed by using the 3D reconstruction images of dural tail sign,and their advantages and disadvantages were evaluated under the guidance of navigation.Results Dural tail sign performed MRI 3D reconstruction could reveal its overall picture.Most of dural tail signs around the tumors were uneven.The dural tail sign extended farther nearby the dural vessels.The vertical diameters of dural tail sign measured on contrast-enhanced T1-MRI were 2.74-7.54 cm (mean 4.67 ± 1.234 cm);the vertical diameters of dural tail sign measured on 3D reconstruction irrages were 2.75-7.64 cm (mean 4.70 ± 1.249 cm).There was no significant difference between both of them (P ＞ 0.05).The anteroposterior diameters of dural tail sign measured on contrast-enhanced T1-MRI were 2.84-7.61 cm (mean 4.81 ± 1.19 cm);the anteroposterior diameters of dural tail sign measured on 3D reconstruction images were 2.88-7.74 cm (mean 4.85 ± 1.22 cm).There was no significant difference between both of them (P ＞0.05).Designing surgical incisions referring dural tail sign 3D reconstruction images,the excellent rate was up to 91％.Conclusion MRI 3D reconstruction can intuitively and accurately reveal the range and shape of dural tail sign,and thus provide evidence for meningioma incision design and dural resection range.