Pereira Philippe L, Fritz Jan, Koenig Claudius W, Maurer Franz, Boehm Paul, Badke Andreas, Mueller-Schimpfle Markus, Bitzer Michael, Claussen Claus D
Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen, Germany.
J Bone Joint Surg Am. 2004 Aug;86(8):1761-7. doi: 10.2106/00004623-200408000-00021.
The purpose of this study was to evaluate a new stereotactic method for preoperative coil-marking of musculoskeletal tumors with use of interventional magnetic resonance imaging.
Nine patients with a soft-tissue or bone-marrow tumor were referred to our department for preoperative marking of the extent of the lesion. In one patient, two lesions were marked. Guidance for the punctures and the delivery of the coils was provided by an open low-field magnetic resonance imaging system with horizontal access. After imaging of the extent of the lesion, magnetic resonance imaging-compatible titanium coils were placed with use of nearly real-time or step-by-step magnetic resonance imaging control. The coils were placed up to seventy-two hours before the surgery. The inclusion of the tumor borders within the area of the excision was examined with cross-sectional histological analysis of surgical specimens.
The tumor-marking intervention was successfully performed with the guidance of magnetic resonance imaging only in all patients. Preoperatively, nineteen coils were used to mark the ten lesions in the nine patients. All of the coils were easily located with intraoperative fluoroscopy. No coil migrated between the time of the percutaneous marking and the surgery. Histological examination of the resection borders revealed no residual tumor cells. No complications were observed, and, after a mean of twenty-three months of follow-up, no tumor had recurred.
Preoperative coil-marking guided by magnetic resonance imaging for exact delineation of a musculoskeletal tumor is technically feasible and can readily demonstrate the full extent of the tumor. Use of magnetic resonance fluoroscopy reduces the time needed for the intervention. We recommend the coil-marking technique.
本研究的目的是评估一种使用介入性磁共振成像对肌肉骨骼肿瘤进行术前线圈标记的新立体定向方法。
9例软组织或骨髓肿瘤患者被转诊至我科进行术前病变范围标记。其中1例患者标记了2个病变。使用具有水平入口的开放式低场磁共振成像系统为穿刺和线圈放置提供引导。在对病变范围进行成像后，使用近乎实时或逐步的磁共振成像控制放置磁共振成像兼容的钛线圈。线圈在手术前放置长达72小时。通过手术标本的横断面组织学分析检查切除区域内是否包含肿瘤边界。
仅在所有患者中在磁共振成像引导下成功进行了肿瘤标记干预。术前，使用19个线圈标记了9例患者中的10个病变。所有线圈在术中透视下均易于定位。从经皮标记到手术期间，没有线圈发生移位。切除边界的组织学检查未发现残留肿瘤细胞。未观察到并发症，并且在平均随访23个月后，没有肿瘤复发。
由磁共振成像引导的术前线圈标记用于精确描绘肌肉骨骼肿瘤在技术上是可行的，并且可以很容易地显示肿瘤的全貌。使用磁共振透视减少了干预所需的时间。我们推荐线圈标记技术。
