Stadlbauer Andreas, Merkel Andreas, Zimmermann Max, Sommer Björn, Buchfelder Michael, Meyer-Bäse Anke, Rössler Karl
Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany; Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria.
Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.
World Neurosurg. 2017 Apr;100:388-394. doi: 10.1016/j.wneu.2017.01.060. Epub 2017 Jan 27.
Tissue oxygen tension is an important parameter for brain tissue viability and its noninvasive intraoperative monitoring in the whole brain is of highly clinical relevance. The purpose of this study was the introduction of a multiparametric quantitative blood oxygenation dependent magnetic resonance imaging (MRI) approach for intraoperative examination of oxygen metabolism during the resection of brain lesions.
Sixteen patients suffering from brain lesions were examined intraoperatively twice (before craniotomy and after gross-total resection) via the quantitative blood oxygenation dependent technique and a 1.5-Tesla MRI scanner, which is installed in an operating room. The MRI protocol included T2*- and T2 mapping and dynamic susceptibility weighted perfusion. Data analysis was performed with a custom-made, in-house MatLab software for calculation of maps of oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO) as well as of cerebral blood volume and cerebral blood flow.
Perilesional edema showed a significant increase in both perfusion (cerebral blood volume +21%, cerebral blood flow +13%) and oxygen metabolism (OEF +32%, CMRO +16%) after resection of the lesions. In perilesional nonedematous tissue only, however, oxygen metabolism (OEF +19%, CMRO +11%) was significantly increased, but not perfusion. No changes were found in normal brain. Fortunately, no neurovascular adverse events were observed.
This approach for intraoperative examination of oxygen metabolism in the whole brain is a new application of intraoperative MRI additionally to resection control (residual tumor detection) and updating of neuronavigation (brain shift detection). It may help to detect neurovascular adverse events early during surgery.
组织氧张力是评估脑组织活力的重要参数，其全脑无创术中监测具有高度临床相关性。本研究旨在引入一种多参数定量血氧依赖性功能磁共振成像（MRI）方法，用于在脑病变切除术中检测氧代谢情况。
对16例脑病变患者在术中通过定量血氧依赖性功能磁共振成像技术及安装在手术室的1.5T MRI扫描仪进行了两次检查（开颅术前和肿瘤全切术后）。MRI检查方案包括T2*和T2成像以及动态磁敏感加权灌注成像。数据分析采用定制的内部MatLab软件，以计算氧摄取分数（OEF）和脑氧代谢率（CMRO）以及脑血容量和脑血流量的图谱。
病变切除后，瘤周水肿区域的灌注（脑血容量增加21%，脑血流量增加13%）和氧代谢（OEF增加32%，CMRO增加16%）均显著增加。然而，仅在瘤周非水肿组织中，氧代谢（OEF增加19%，CMRO增加11%）显著增加，而灌注未增加。正常脑组织未见变化。幸运的是，未观察到神经血管不良事件。
这种全脑氧代谢术中检测方法是术中MRI除用于切除控制（残留肿瘤检测）和神经导航更新（脑移位检测）之外的一项新应用。它可能有助于在手术早期检测神经血管不良事件。
