Rao Arun S, Thakar Sumit, Sai Kiran Narayanam Anantha, Aryan Saritha, Mohan Dilip, Hegde Alangar S
Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
World Neurosurg. 2018 Jan;109:e426-e433. doi: 10.1016/j.wneu.2017.09.199. Epub 2017 Oct 7.
Three-dimensional (3D) time of flight (TOF) imaging is the current gold standard for noninvasive, preoperative localization of lenticulostriate arteries (LSAs) in insular gliomas; however, the utility of this modality depends on tumor intensity.
Over a 3-year period, 48 consecutive patients with insular gliomas were prospectively evaluated. Location of LSAs and their relationship with the tumor were determined using a combination of contrast-enhanced coronal 3D TOF magnetic resonance angiography and coronal 3D constructive interference in steady state (CISS) sequences. These findings were analyzed with respect to extent of tumor resection and early postoperative motor outcome.
Tumor was clearly visualized in 29 (60.4%) patients with T1-hypointense tumors using 3D TOF and in all patients using CISS sequences. Using combined 3D TOF and CISS, LSA-tumor interface was well seen in 47 patients, including all patients with T1-heterointense or T1-isointense tumors. Extent of resection was higher in the LSA-pushed group compared with the LSA-encased group. In the LSA-encased group, 6 (12.5%) patients developed postoperative hemiparesis; 2 (4.2%) cases were attributed to LSA injury.
Contrast-enhanced 3D TOF can delineate LSAs in almost all insular gliomas but is limited in identifying the LSA-tumor interface. This limitation can be overcome by addition of analogous CISS sequences that delineate the LSA-tumor interface regardless of tumor intensity. Combined 3D TOF and 3D CISS is a useful tool for surgical planning and safer resections of insular tumors and may have added surgical relevance when included as an intraoperative adjunct.
三维（3D）时间飞跃（TOF）成像术是目前用于岛叶胶质瘤中豆纹动脉（LSA）无创术前定位的金标准；然而，这种方式的效用取决于肿瘤的强化程度。
在3年的时间里，对48例连续的岛叶胶质瘤患者进行了前瞻性评估。通过对比增强冠状位3D TOF磁共振血管造影和冠状位3D稳态构成干扰序列（CISS）相结合的方法，确定LSA的位置及其与肿瘤的关系。分析这些结果与肿瘤切除范围和术后早期运动结果的相关性。
使用3D TOF在29例（60.4%）T1低信号肿瘤患者中可清晰显示肿瘤，而使用CISS序列在所有患者中均可清晰显示肿瘤。联合使用3D TOF和CISS，在47例患者中可清晰看到LSA-肿瘤界面，包括所有T1等信号或T1混杂信号肿瘤患者。LSA推移组的切除范围高于LSA包绕组。在LSA包绕组中，6例（12.5%）患者术后出现偏瘫；2例（4.2%）归因于LSA损伤。
对比增强3D TOF几乎可在所有岛叶胶质瘤中勾勒出LSA，但在识别LSA-肿瘤界面方面存在局限性。通过添加类似的CISS序列可克服这一局限性，该序列可不管肿瘤强化程度而勾勒出LSA-肿瘤界面。联合3D TOF和3D CISS是手术规划和更安全切除岛叶肿瘤的有用工具，作为术中辅助手段时可能具有更大的手术相关性。
