Gruber Philipp, Schwyzer Lucia, Klinger Elisabeth, Burn Felice, Diepers Michael, Anon Javier, Fathi Ali, Fandino Javier, Remonda Luca, Roelcke Ulrich, Berberat Jatta
Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland; Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
Department of Neurosurgery and Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland.
World Neurosurg. 2018 Dec;120:e357-e364. doi: 10.1016/j.wneu.2018.08.078. Epub 2018 Aug 23.
To describe longitudinal image changes in supratentorial hemispheric meningiomas based on magnetic resonance imaging after preoperative embolization using calibrated microspheres.
A total of 14 patients with symptomatic supratentorial meningiomas were included in a prospective, mono-centric, mono-arm study. Magnetic resonance imaging changes on diffusion-weighted imaging, dynamic contrast susceptibility-perfusion-weighted imaging, susceptibility-weighted imaging, and magnetization-prepared rapid acquisition gradient-echo sequence T1-weighted postcontrast sequences 6 and 48 hours after embolization were evaluated and correlated with angiographic and clinical data.
The mean age of the patients was 63 ± 12.7 years with an equal female/male ratio. Twelve meningiomas were World Health Organization grade I and II tumors. After embolization, baseline apparent diffusion coefficient (901 ± 166 mm/s) decreased significantly within 6 hours (696 ± 115 mm2/s, P = 0.0008) as well within 48 hours (752 ± 134 mm/s; P = 0.0147). Baseline mean ratio of relative cerebral blood volume (rCBV)/rCBV (3.67 ± 1.83) and relative cerebral blood flow (rCBF)/rCBF (2.89 ± 1.57) significantly decreased after embolization within 6 hours (rCBV/rCBV of 1.45 ± 0.9; P = 0.0007, rCBF of 1.16 ± 0.68; P = 0.0029) and 48 hours (rCBV of 1.50 ± 1.07; P = 0.0009, rCBF/rCBF of 1.19 ± 0.8; P = 0.003). The viable enhanced baseline mean tumor volume (54.3 ± 34.9 mm) was sustainably and significantly diminished within 6 hours (26.6 ± 20.8 mm; P = 0.02) and 48 hours (29.7 ± 22.5 mm; P = 0.035) after embolization. There was a good correlation between angiographic devascularization rate and the embolized tumor volume at 6 hours (r = 0.7; P = 0.03) and 48 hours (r = 0.78; P = 0.041).
Preoperative meningioma embolization with calibrated microspheres is safe and effectively induces a significant and sustainable tissue transformation over 48 hours.
基于使用校准微球进行术前栓塞后的磁共振成像，描述幕上半球脑膜瘤的纵向图像变化。
14例有症状的幕上脑膜瘤患者纳入一项前瞻性、单中心、单臂研究。评估栓塞后6小时和48小时在扩散加权成像、动态对比剂敏感灌注加权成像、磁敏感加权成像以及磁化准备快速采集梯度回波序列T1加权增强序列上的磁共振成像变化，并与血管造影和临床数据相关联。
患者的平均年龄为63±12.7岁，男女比例相等。12例脑膜瘤为世界卫生组织I级和II级肿瘤。栓塞后，基线表观扩散系数（901±166mm²/s）在6小时内（696±115mm²/s，P = 0.0008）以及48小时内（752±134mm/s；P = 0.0147）均显著降低。基线相对脑血容量（rCBV）/rCBV平均比值（3.67±1.83）和相对脑血流量（rCBF）/rCBF平均比值（2.89±1.57）在栓塞后6小时内（rCBV/rCBV为1.45±0.9；P = 0.0007，rCBF为1.16±0.68；P = 0.0029）和48小时内（rCBV为1.50±1.07；P = 0.0009，rCBF/rCBF为1.19±0.8；P = 0.003）均显著下降。存活增强的基线平均肿瘤体积（54.3±34.9mm）在栓塞后6小时（26.6±20.8mm；P = 0.02）和48小时（29.7±22.5mm；P = 0.035）可持续且显著减小。血管造影去血管化率与6小时（r = 0.7；P = 0.03）和48小时（r = 0.78；P = 0.041）时栓塞的肿瘤体积之间存在良好相关性。
使用校准微球进行术前脑膜瘤栓塞是安全的，并且在48小时内可有效诱导显著且持续的组织变化。
