Komatsu Katsuya, Wanibuchi Masahiko, Mikami Takeshi, Akiyama Yukinori, Iihoshi Satoshi, Miyata Kei, Sugino Toshiya, Suzuki Kengo, Kanno Aya, Noshiro Shouhei, Ohtaki Shunya, Mikuni Nobuhiro
Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
World Neurosurg. 2018 Jun;114:e495-e500. doi: 10.1016/j.wneu.2018.03.015. Epub 2018 Mar 9.
Preoperative evaluation of malignancy in gliomas is important for surgical planning, particularly to determine whether a 1,3-bis-2-chloroethyl-1-nitrosourea wafer should be placed into the tumor cavity. In some cases, the intraoperative pathologic diagnosis of World Health Organization grade differs from the final diagnosis. Supplemental methods in addition to the routine contrast tomography or magnetic resonance imaging sequences may provide a more accurate preoperative diagnosis. Because tumor vascularity has been useful in distinguishing between low- and high-grade gliomas, we evaluated the accuracy of the arterial spin labeling (ASL) method, which could measure the cerebral blood flow (CBF) without using contrast medium, to determine the malignancy of gliomas.
This study included 102 patients with glioma (grade II, n = 40; grade III, n = 18; grade IV, n = 44). All patients underwent ASL to determine the tumor blood flow (TBF) and CBF in the middle cerebral region. The relative tumor vascular index (tVI), which is calculated as TBF divided by CBF in the contralateral middle cerebral region, was used to avoid dispersion of the absolute TBF value.
tVI was significantly greater (1.46 ± 0.751) in high-grade gliomas than in low-grade gliomas (1.05 ± 0.343) (P = 0.003). As for each grade, tVI was statistically higher in grade IV than in grade II (P = 0.03) gliomas.
The noninvasive ASL method provides additional information to distinguish high-grade glioma from low-grade gliomas without using contrast medium.
胶质瘤恶性程度的术前评估对于手术规划很重要，特别是对于确定是否应在肿瘤腔内放置1,3 - 双（2 - 氯乙基）-1 - 亚硝基脲薄片而言。在某些情况下，世界卫生组织分级的术中病理诊断与最终诊断不同。除了常规的对比断层扫描或磁共振成像序列外，补充方法可能会提供更准确的术前诊断。由于肿瘤血管情况有助于区分低级别和高级别胶质瘤，我们评估了动脉自旋标记（ASL）方法的准确性，该方法可以在不使用造影剂的情况下测量脑血流量（CBF），以确定胶质瘤的恶性程度。
本研究纳入了102例胶质瘤患者（二级，n = 40；三级，n = 18；四级，n = 44）。所有患者均接受ASL检查，以确定大脑中区域的肿瘤血流量（TBF）和CBF。相对肿瘤血管指数（tVI）通过将TBF除以对侧大脑中区域的CBF来计算，用于避免绝对TBF值的离散。
高级别胶质瘤的tVI（1.46±0.751）显著高于低级别胶质瘤（1.05±0.343）（P = 0.003）。对于每个级别，四级胶质瘤的tVI在统计学上高于二级胶质瘤（P = 0.03）。
无创ASL方法无需使用造影剂即可提供额外信息，以区分高级别胶质瘤和低级别胶质瘤。
