Benveniste Ronald J, Ferraro Nicholas, Tsimpas Asterios
Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace (D4-6), Miami, FL, 33136-1060, USA.
Department of Neurological Surgery, Jefferson Medical College, Philadelphia, PA, USA.
J Neurooncol. 2014 Jun;118(2):363-367. doi: 10.1007/s11060-014-1440-3. Epub 2014 Apr 16.
Magnetic resonance imaging (MRI) or computerized tomography (CT) is routinely performed after resection of brain metastases (BrM), regardless of whether there are specific clinical concerns about residual tumor or potential complications. Routine imaging studies contribute a significant amount to the cost of medical care, and their yield and utility are unknown. An IRB-approved retrospective chart review study was performed to analyze all craniotomies for BrM performed at our institution from 2005 to 2012. Descriptive statistics were used to quantify the yield of postoperative imaging. 218 consecutive patients underwent 226 craniotomies for BrM. In 21 cases, new or worsened neurologic deficits occurred after surgery (9.0%), and 19 of the 21 underwent postoperative imaging. 9 of the 19 patients (47%) had significant findings on postoperative imaging, and 2 patients required reoperation. 201 patients had no new neurologic deficits (91%), and 23 of these patients had no postoperative imaging. Of the 178 remaining patients, 160 underwent postoperative MRI and 18 underwent postoperative CT. 9 patients (5.1%) had unexpected adverse imaging findings; 6 had small stroke, 1 had a subdural hemorrhage and 2 had possible or definite venous sinus occlusion. None of the imaging findings led to changes in management. 182 patients underwent imaging appropriate to detect residual tumor (177 gadolinium enhanced MRI and 5 contrast enhanced CT). Of these patients, 16 were known to have small residual tumors based on intraoperative findings. Of the remaining 166 patients felt to have had gross total tumor resection, 9 (5.4%) were found to have a small amount of residual tumor on postoperative imaging; no patient had a change in treatment plan as a result. Routine postoperative imaging in patients undergoing craniotomy for BrM has a very low yield and may not be appropriate in the absence of new neurologic deficits, or specific clinical concerns about large amounts of residual tumor or intraoperative complications.
无论对残留肿瘤或潜在并发症是否存在特定临床担忧，脑转移瘤（BrM）切除术后通常都会进行磁共振成像（MRI）或计算机断层扫描（CT）。常规影像学检查在医疗费用中占比很大，但其检出率和实用性尚不清楚。我们进行了一项经机构审查委员会批准的回顾性病历审查研究，以分析2005年至2012年在我们机构进行的所有BrM开颅手术。使用描述性统计来量化术后影像学检查的检出率。218例连续患者因BrM接受了226次开颅手术。21例患者术后出现新的或加重的神经功能缺损（9.0%），其中21例中的19例接受了术后影像学检查。19例患者中有9例（47%）术后影像学检查有显著发现，2例患者需要再次手术。201例患者没有新的神经功能缺损（91%），其中23例患者未进行术后影像学检查。在其余178例患者中，160例接受了术后MRI检查，18例接受了术后CT检查。9例患者（5.1%）出现意外的不良影像学发现；6例为小中风，1例为硬膜下出血，2例可能或确定有静脉窦闭塞。所有影像学发现均未导致治疗方案改变。182例患者接受了适合检测残留肿瘤的影像学检查（177例钆增强MRI和5例对比增强CT）。在这些患者中，根据术中发现已知16例有小的残留肿瘤。在其余166例被认为已进行肿瘤全切的患者中,9例（5.4%）术后影像学检查发现有少量残留肿瘤；没有患者因此改变治疗方案。接受BrM开颅手术患者的常规术后影像学检查检出率非常低，在没有新的神经功能缺损，或对大量残留肿瘤或术中并发症没有特定临床担忧的情况下，可能并不合适。
