Engh Johnathan A, Flickinger John C, Niranjan Ajay, Amin Devin V, Kondziolka Douglas S, Lunsford L Dade
Department of Neurological Surgery, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Stereotact Funct Neurosurg. 2007;85(4):162-8. doi: 10.1159/000099075. Epub 2007 Jan 26.
The authors characterize the detection of additional intracranial metastases in cancer patients at the time of stereotactic radiosurgery (SRS) using a specialized high-resolution magnetic resonance imaging (MRI) protocol.
A retrospective review of 150 consecutive radiosurgical procedures for patients with < or =5 known metastatic intracranial tumors diagnosed using MRI was undertaken at a single center. On the day of SRS, all patients underwent rigid head fixation in a stereotactic frame followed by a specialized MRI using a 3-dimensional fast spoiled-gradient sequence on a 1.5-tesla magnet with double-dose gadolinium. Axial imaging was performed using 2-mm cuts and no gap.
Additional metastases were detected in 29.3% of patients. The number of known tumors before SRS was predictive of additional metastases being found (p = 0.014). In multivariate analysis, we more frequently found additional metastases at radiosurgery in patients with 3-5 previously known metastases (p = 0.005), in patients with non-small cell lung cancer (p = 0.012) and in patients with a longer time interval between their diagnostic MRI and their stereotactic MRI (p = 0.030). Age, sex and prior fractionated radiation therapy were not predictive factors.
Our specialized protocol of high-resolution, double-dose contrast-enhanced MRI is a reliable method to evaluate the extent of intracranial disease in patients with known brain metastasis. Treatment planning for radiosurgery, radiation therapy and open surgical therapy are all impacted by improved metastasis detection.
作者利用一种专门的高分辨率磁共振成像（MRI）方案，对癌症患者在立体定向放射外科治疗（SRS）时额外颅内转移灶的检测情况进行了特征描述。
在单一中心对150例连续接受放射外科治疗的患者进行回顾性研究，这些患者经MRI诊断为已知颅内转移瘤≤5个。在SRS当天，所有患者在立体定向框架中进行头部刚性固定，然后在1.5特斯拉磁体上使用三维快速扰相梯度序列及双倍剂量钆剂进行专门的MRI检查。轴向成像层厚2毫米且无间隔。
29.3%的患者检测到额外转移灶。SRS前已知肿瘤的数量可预测是否会发现额外转移灶（p = 0.014）。多因素分析显示，在放射外科治疗时，我们更常于以下患者中发现额外转移灶：先前已知有3 - 5个转移灶的患者（p = 0.0
