Gao Qiang, Zhang Lan, Wang Guoqing, Xu Dingkang, Feng Mengzhao, Wang Fang, Wei Qingjie, Liu Xianzhi, Guo Fuyou
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Department of MRI, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450003, China.
Quant Imaging Med Surg. 2019 Nov;9(11):1781-1791. doi: 10.21037/qims.2019.09.05.
A solid hemangioblastoma (SH) is a benign and highly vascularized tumor. Microsurgical treatment of SH is still challenging due to excessive intraoperative bleeding.
Sixty-six consecutive patients with SH were retrospectively analyzed. The volume of intraoperative blood loss (IBL) and the features detected by magnetic resonance imaging (MRI) were evaluated by a neurosurgeon and multiple neuroradiologists.
Four striking MRI features-peritumoral edema, the flow-void effect, large draining veins, and a visible feeding artery-were related to excessive IBL. Regarding the weighted values of these risk factors, the flow-void effect was the factor most significantly correlated with IBL (P<0.01, R=0.418). The feeding artery also contributed substantially to excessive IBL (P<0.05, R=0.412). The next most influential factor was the presence of large draining veins (P<0.05, R=0.350), followed by peritumoral edema (P<0.05, R=0.308). The four major risk factors-the flow-void effect, feeding arteries, large draining veins, and peritumoral edema-were assigned point values of 3, 3, 2, and 1, respectively, for a maximum total score of 9 points. A higher total score indicates that a higher volume of bleeding is more likely to occur during surgery.
This study reports the potential neuroimaging-based risk factors leading to abundant IBL in SH by neuroimaging assessment. The study proposes a novel scoring system to predict IBL, potentially decreasing the risk involved in the surgical treatment of SH.
实性血管母细胞瘤（SH）是一种良性且血管高度丰富的肿瘤。由于术中出血过多，SH的显微外科治疗仍然具有挑战性。
对66例连续的SH患者进行回顾性分析。神经外科医生和多名神经放射科医生评估术中失血量（IBL）以及磁共振成像（MRI）检测到的特征。
四个显著的MRI特征——瘤周水肿、流空效应、粗大引流静脉和可见供血动脉——与过多的IBL相关。关于这些危险因素的加权值，流空效应是与IBL最显著相关的因素（P<0.01，R=0.418）。供血动脉对过多的IBL也有很大影响（P<0.05，R=0.412）。其次最有影响的因素是存在粗大引流静脉（P<0.05，R=0.350），其次是瘤周水肿（P<0.05，R=0.308）。四个主要危险因素——流空效应、供血动脉、粗大引流静脉和瘤周水肿——分别赋予3分、3分、2分和1分，最高总分9分。总分越高表明手术中发生更高出血量的可能性越大。
本研究通过神经影像学评估报告了导致SH术中大量IBL的潜在基于神经影像学的危险因素。该研究提出了一种新的评分系统来预测IBL，可能降低SH手术治疗中涉及的风险。
