Department of Neurosurgery, Cleveland Clinic Florida Egil and Pauline Braathen Center, Neurological Institute, Cleveland Clinic, Weston, Florida, USA.
Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.
World Neurosurg. 2021 Apr;148:e502-e507. doi: 10.1016/j.wneu.2021.01.015. Epub 2021 Jan 11.
The magnetic resonance imaging sequence used to assess optic canal invasion by tuberculum sella meningiomas (TSMs) has not been standardized. Both constructive interference in steady state (CISS) and contrast-enhanced T1-weighted volume-interpolated breath-hold examination (VIBE) sequences are frequently used. The aim of the present study was to compare the accuracy and interrater reliability of these sequences in predicting optic canal invasion by TSMs.
In the present retrospective study of 27 patients (54 optic canals) who had undergone endoscopic transtuberculum transplanum resection of TSMs, images from preoperative CISS and contrast-enhanced T1-weighted VIBE sequences were assessed by 5 neuroradiologists who were unaware of the operative findings. The readers evaluated the optic canal in 4 quadrants at 2 locations (the posterior tip of the anterior clinoid process and the optic strut). A quadrant was considered positive for tumor invasion if invasion was present at either of these 2 locations. The reference standard was intraoperative observation of gross optic canal invasion.
The interrater agreement was good for the presence or absence of tumor involvement in a particular quadrant (CISS, 0.635; VIBE, 0.643; 95% confidence interval for the difference, -0.086 to 0.010). The mean sensitivity and specificity for optic nerve invasion were 0.643 and 0.438 with CISS and 0.643 and 0.454 with VIBE, respectively. No significant differences were seen between the sequences in terms of reader accuracy when the intraoperative findings were used as the reference standard.
CISS and VIBE sequences both have good accuracy in predicting for optic canal tumor invasion by TMEs.
用于评估鞍结节脑膜瘤（TSM）对视神经管侵袭的磁共振成像序列尚未标准化。稳态构建干扰（CISS）和对比增强 T1 加权容积内插呼吸暂停检查（VIBE）序列经常被使用。本研究的目的是比较这些序列在预测 TSM 对视神经管侵袭的准确性和组内一致性。
在本回顾性研究中，对 27 例（54 个视神经管）接受内镜经鞍结节经蝶窦切除 TSM 的患者进行了研究。5 名神经放射科医生对术前 CISS 和对比增强 T1 加权 VIBE 序列进行了评估，他们不知道手术结果。读者在 4 个象限的 2 个位置（前床突的后尖和视神经柱）评估视神经管。如果在这两个位置中的任何一个位置存在肿瘤侵犯，则认为象限存在肿瘤侵犯。参考标准是术中观察到的视神经管大体侵犯。
对于特定象限是否存在肿瘤侵犯，观察者之间的一致性较好（CISS，0.635；VIBE，0.643；差异的 95%置信区间，-0.086 至 0.010）。CISS 和 VIBE 分别用于视神经侵犯的平均灵敏度和特异性为 0.643 和 0.438，0.643 和 0.454。当以术中发现为参考标准时，两种序列在读者准确性方面没有显著差异。
CISS 和 VIBE 序列在预测 TME 对视神经管肿瘤侵犯方面均具有良好的准确性。
