H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, 12902 Magnolia Drive, Tampa, Florida 33612, USA.
J Neurosurg Spine. 2010 Sep;13(3):371-80. doi: 10.3171/2010.3.SPINE09399.
The aim of this retrospective study was to evaluate the predictive value of diffusion tensor (DT) imaging with respect to resectability of intramedullary spinal cord tumors and to determine the concordance of this method with intraoperative surgical findings.
Diffusion tensor imaging was performed in 14 patients with intramedullary lesions of the spinal cord at different levels using a 3-T magnet. Routine MR imaging scans were also obtained, including unenhanced and enhanced T1-weighted images and T2-weighted images. Patients were classified according to the fiber course with respect to the lesion and their lesions were rated as resectable or nonresectable. These results were compared with the surgical findings (existence vs absence of cleavage plane). The interrater reliability was calculated using the kappa coefficient of Cohen.
Of the 14 patients (7 male, 7 female; mean age 49.2 +/- 15.5 years), 13 had tumors (8 ependymomas, 2 lymphomas, and 3 astrocytoma). One lesion was proven to be a multiple sclerosis plaque during further diagnostic workup. The lesions could be classified into 3 types according to the fiber course. In Type 1 (5 cases) fibers did not pass through the solid lesion. In Type 2 (3 cases) some fibers crossed the lesion, but most of the lesion volume did not contain fibers. In Type 3 (6 cases) the fibers were completely encased by tumor. Based on these results, 6 tumors were considered resectable, 7 were not. During surgery, 7 tumors showed a good cleavage plane, 6 did not. The interrater reliability (Cohen kappa) was calculated as 0.83 (p < 0.003), which is considered to represent substantial agreement. The mean duration of follow-up was 12.0 +/- 2.9. The median McCormick grade at the end of follow-up was II.
These preliminary data suggest that DT imaging in patients with spinal cord tumors is capable of predicting the resectability of the lesion. A further prospective study is needed to confirm these results and any effect on patient outcome.
本回顾性研究旨在评估弥散张量（DT）成像在预测脊髓髓内肿瘤可切除性方面的价值，并确定该方法与术中手术结果的一致性。
使用 3T 磁铁对 14 例不同节段脊髓内病变患者进行弥散张量成像。还获得了常规磁共振成像扫描，包括未增强和增强 T1 加权像和 T2 加权像。根据病变与纤维束的关系对患者进行分类，并将其病变分为可切除或不可切除。这些结果与手术结果（有无分割面）进行比较。采用 Cohen 的kappa 系数计算组内一致性。
14 例患者（7 例男性，7 例女性；平均年龄 49.2+/-15.5 岁）中，13 例为肿瘤（8 例室管膜瘤、2 例淋巴瘤和 3 例星形细胞瘤）。1 例病变在进一步诊断性检查中被证实为多发性硬化斑块。根据纤维束的走向，病变可分为 3 型。在 1 型（5 例）中，纤维不穿过实体性病变。在 2 型（3 例）中，一些纤维穿过病变，但病变体积的大部分不包含纤维。在 3 型（6 例）中，纤维完全被肿瘤包裹。根据这些结果，6 例肿瘤被认为可切除，7 例不可切除。在手术中，7 例肿瘤显示出良好的分割面，6 例没有。组内一致性（Cohen kappa）计算为 0.83（p<0.003），认为是高度一致的。平均随访时间为 12.0+/-2.9 个月。随访结束时的中位 McCormick 分级为 II 级。
这些初步数据表明，脊髓肿瘤患者的 DT 成像能够预测病变的可切除性。需要进一步的前瞻性研究来证实这些结果以及对患者预后的任何影响。
