Zhu Weijie, Chen Xiaolei, Zhang Jiashu, Li Fangye, Wu Dongdong, Zhang Meng, Zhang Huaping, Song Zhijun, Xu Bainan
Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China. Email:
Zhonghua Wai Ke Za Zhi. 2014 Apr;52(4):280-4.
To evaluate the feasibility, reliability and accuracy of the automated magnetic resonance spectroscopy ((1)H-MRS) guided frameless brain biopsy with intraoperative magnetic resonance imaging (iMRI).
Between July 2011 and July 2013, a consecutive series of 93 patients were prospectively enrolled. All the patients had intracranial lesions which need biopsy to confirm the diagnosis. Among them, 48 patients were male, 45 patients were female. Their age range from 7 years to 76 years, the median age was 47 years. All patients underwent MRS examination. With MRS automatic fusion technique, the metabolic images were integrated into a standard navigation system (Vario Guide) to guide frameless biopsy. High-field iMRI (1.5 T) was used for target inspection, brain shift correction, and intra-operative exclusion of intra-cerebral hemorrhage and other complications.
For all the 93 patients, (1)H-MRS based metabolic images could be automatically integrated into a standard navigation system and average fusion procedure could be taken 5 minutes 6 seconds. For (1)H-MRS guided stereotactic biopsy of intracranial lesions, the diagnosis yield rate was 94.6% (88/93). Four cases did not get a clear pathological diagnosis, while 1 case did not match the pathological diagnosis result which obtained by following craniotomy. Technical related complication rate was 2.2% (2 cases, intra-cerebral hemorrhage), which were intra-operatively depicted with iMRI, and managed properly. Among them, 1 case with small volume (5 ml) intracerebral hematoma fully recovered 10 days after surgery without second surgical intervention. One case with large volume intracerebral hematoma (32 ml) was depicted with iMRI, followed by craniotomy and hematoma evacuation in the same session. This case had no new or worsened neurologic deficit post-operatively.
(1)H-MRS based metabolic imaging can be automatically integrated into a standard navigation system and used for frameless brain biopsy. The target can be selected according to the metabolic status of the lesion. Hence, the target can be more accurate. And the pathological diagnosis yield rate is higher. With iMRI, the method is safe, and has high clinical efficacy.
评估术中磁共振成像（iMRI）引导下的自动化磁共振波谱（（1）H-MRS）引导的无框架脑活检的可行性、可靠性和准确性。
2011年7月至2013年7月，前瞻性纳入连续93例患者。所有患者均有颅内病变需要活检以明确诊断。其中男性48例，女性45例。年龄范围为7岁至76岁，中位年龄为47岁。所有患者均接受了MRS检查。采用MRS自动融合技术，将代谢图像整合到标准导航系统（Vario Guide）中以引导无框架活检。使用高场iMRI（1.5 T）进行靶点检查、脑移位校正以及术中排除脑出血等并发症。
93例患者中，基于（1）H-MRS的代谢图像均可自动整合到标准导航系统中，平均融合过程耗时5分6秒。对于（1）H-MRS引导的颅内病变立体定向活检，诊断阳性率为94.6%（88/93）。4例未获得明确病理诊断，1例与后续开颅手术获得的病理诊断结果不符。技术相关并发症发生率为2.2%（2例，脑出血），术中通过iMRI发现并得到妥善处理。其中，1例小体积（5 ml）脑内血肿患者术后10天完全恢复，无需二次手术干预。1例大体积脑内血肿（32 ml）患者经iMRI发现，随后在同一次手术中进行开颅血肿清除术。该患者术后无新的或加重的神经功能缺损。
基于（1）H-MRS的代谢成像可自动整合到标准导航系统中，用于无框架脑活检。可根据病变的代谢状态选择靶点，从而使靶点更准确，病理诊断阳性率更高。结合iMRI，该方法安全且临床疗效高。
