Sakai N, Takehara Y, Yamashita S, Ohishi N, Kawaji H, Sameshima T, Baba S, Sakahara H, Namba H
From the Departments of Neurosurgery (N.S., H.K., T.S., H.N.)
Radiology (Y.T., N.O.).
AJNR Am J Neuroradiol. 2016 Oct;37(10):1851-1859. doi: 10.3174/ajnr.A4832. Epub 2016 Jun 23.
The stiffness of intracranial tumors affects the outcome of tumor removal. We evaluated the stiffness of 4 common intracranial tumors by using MR elastography and tested whether MR elastography had the potential to discriminate firm tumors preoperatively.
Thirty-four patients with meningiomas, pituitary adenomas, vestibular schwannomas, and gliomas scheduled for resection were recruited for MR elastography. On the elastogram, the mean and the maximum shear stiffnesses were measured by placing an ROI on the tumor. Blinded to the MR elastography findings, surgeons conducted qualitative intraoperative assessment of tumor consistency by using a 5-point scale. Histopathologic diagnosis was confirmed by using the resected specimens. The mean and maximum shear stiffnesses were compared with histopathologic subtypes, and the intraoperative tumor consistency was graded by the surgeons.
The mean and maximum shear stiffnesses were the following: 1.9 ± 0.8 kPa and 3.4 ± 1.5 kPa for meningiomas, 1.2 ± 0.3 kPa and 1.8 ± 0.5 kPa for pituitary adenomas, 2.0 ± 0.4 kPa and 2.7 ± 0.8 kPa for vestibular schwannomas, and 1.5 ± 0.2 kPa and 2.7 ± 0.8 kPa for gliomas. The mean and maximum shear stiffnesses for meningiomas were higher than those of pituitary adenomas ( < .05). The mean and maximum shear stiffnesses were significantly correlated with the surgeon's qualitative assessment of tumor consistency ( < .05). The maximum shear stiffness for 5 firm tumors was higher than that of nonfirm tumors ( < .05).
MR elastography could evaluate intracranial tumors on the basis of their physical property of shear stiffness. MR elastography may be useful in discriminating firm tumors preoperatively.
颅内肿瘤的硬度会影响肿瘤切除的效果。我们通过磁共振弹性成像评估了4种常见颅内肿瘤的硬度,并测试了磁共振弹性成像术前鉴别质地硬的肿瘤的潜力。
招募34例计划行切除术的脑膜瘤、垂体腺瘤、前庭神经鞘瘤和胶质瘤患者进行磁共振弹性成像检查。在弹性图上,通过在肿瘤上放置感兴趣区来测量平均和最大剪切硬度。在不知道磁共振弹性成像结果的情况下,外科医生使用5分制对肿瘤质地进行术中定性评估。通过切除的标本确诊组织病理学诊断。将平均和最大剪切硬度与组织病理学亚型进行比较,并由外科医生对术中肿瘤质地进行分级。
平均和最大剪切硬度如下:脑膜瘤为1.9±0.8 kPa和3.4±1.5 kPa,垂体腺瘤为1.2±0.3 kPa和1.8±0.5 kPa,前庭神经鞘瘤为2.0±0.4 kPa和2.7±0.8 kPa,胶质瘤为1.5±0.2 kPa和2.7±0.8 kPa。脑膜瘤的平均和最大剪切硬度高于垂体腺瘤(P<0.05)。平均和最大剪切硬度与外科医生对肿瘤质地的定性评估显著相关(P<0.05)。5例质地硬的肿瘤的最大剪切硬度高于质地不硬的肿瘤(P<*.*05)。
磁共振弹性成像可根据颅内肿瘤的剪切硬度物理特性对其进行评估。磁共振弹性成像在术前鉴别质地硬的肿瘤方面可能有用。