Tanji Masahiro, Mineharu Yohei, Sakata Akihiko, Okuchi Sachi, Fushimi Yasutaka, Oishi Masahiro, Terada Yukinori, Sano Noritaka, Yamao Yukihiro, Arakawa Yoshiki, Yoshida Kazumichi, Miyamoto Susumu
1Department of Neurosurgery, and.
2Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Neurosurg. 2022 May 13;138(1):120-127. doi: 10.3171/2022.4.JNS212505. Print 2023 Jan 1.
This study aimed to examine the association of preoperative intratumoral susceptibility signal (ITSS) grade with hemorrhage after stereotactic biopsy (STB).
The authors retrospectively reviewed 66 patients who underwent STB in their institution. Preoperative factors including age, sex, platelet count, prothrombin time-international normalized ratio, activated thromboplastin time, antiplatelet agent use, history of diabetes mellitus and hypertension, target location, anesthesia type, and ITSS data were recorded. ITSS was defined as a dot-like or fine linear low signal within a tumor on susceptibility-weighted imaging (SWI) and was graded using a 3-point scale: grade 1, no ITSS within the lesion; grade 2, 1-10 ITSSs; and grade 3, ≥ 11 ITSSs. Postoperative final tumor pathology was also reviewed. The association between preoperative variables and the size of postoperative hemorrhage was examined.
Thirty-four patients were men and 32 were women. The mean age was 66.6 years. The most common tumor location was the frontal lobe (27.3%, n = 18). The diagnostic yield of STB was 93.9%. The most common pathology was lymphoma (36.4%, n = 24). The ITSS was grade 1 in 37 patients (56.1%), grade 2 in 14 patients (21.2%), and grade 3 in 15 patients (22.7%). Interobserver agreement for ITSS was almost perfect (weighted kappa = 0.87; 95% CI 0.77-0.98). Age was significantly associated with ITSS (p = 0.0075). Postoperative hemorrhage occurred in 17 patients (25.8%). Maximum hemorrhage diameter (mean ± SD) was 1.78 ± 1.35 mm in grade 1 lesions, 2.98 ± 2.2 mm in grade 2 lesions, and 9.51 ± 2.11 mm in grade 3 lesions (p = 0.01). Hemorrhage > 10 mm in diameter occurred in 10 patients (15.2%), being symptomatic in 3 of them. Four of 6 patients with grade 3 ITSS glioblastomas (66.7%) had postoperative hemorrhages > 10 mm in diameter. After adjusting for age, ITSS grade was the only factor significantly associated with hemorrhage > 10 mm (p = 0.029). Compared with patients with grade 1 ITSS, the odds of postoperative hemorrhage > 10 mm in diameter were 2.57 times higher in patients with grade 2 ITSS (95% CI 0.31-21.1) and 9.73 times higher in patients with grade 3 ITSS (95% CI 1.57-60.5).
ITSS grade on SWI is associated with size of postoperative hemorrhage after STB.
本研究旨在探讨立体定向活检（STB）术前瘤内易感性信号（ITSS）分级与出血之间的关联。
作者回顾性分析了在其机构接受STB的66例患者。记录术前因素，包括年龄、性别、血小板计数、凝血酶原时间-国际标准化比值、活化部分凝血活酶时间、抗血小板药物使用情况、糖尿病和高血压病史、靶点位置、麻醉类型以及ITSS数据。ITSS定义为在磁敏感加权成像（SWI）上肿瘤内的点状或细线性低信号，并采用3分制进行分级：1级，病灶内无ITSS；2级，1 - 10个ITSS；3级，≥11个ITSS。同时回顾术后最终肿瘤病理结果。研究术前变量与术后出血大小之间的关联。
34例为男性，32例为女性。平均年龄为66.6岁。最常见的肿瘤位置是额叶（27.3%，n = 18）。STB的诊断成功率为93.9%。最常见的病理类型是淋巴瘤（36.4%，n = 24）。37例患者（56.1%）的ITSS为1级，14例患者（21.2%）为2级，15例患者（22.7%）为3级。ITSS的观察者间一致性几乎完美（加权kappa = 0.87；95% CI 0.77 - 0.98）。年龄与ITSS显著相关（p = 0.0075）。17例患者（25.8%）发生术后出血。1级病灶的最大出血直径（均值±标准差）为1.78 ± 1.35 mm，2级病灶为2.98 ± 2.2 mm，3级病灶为9.51 ± 2.11 mm（p = 0.01）。直径>10 mm的出血发生在10例患者（15.2%）中，其中3例有症状。6例3级ITSS胶质母细胞瘤患者中有4例（66.7%）术后出血直径>10 mm。在调整年龄后，ITSS分级是与直径>10 mm出血显著相关的唯一因素（p = 0.029）。与1级ITSS患者相比，2级ITSS患者术后出血直径>10 mm的几率高2.57倍（95% CI 0.31 - 21.1），3级ITSS患者高9.73倍（95% CI 1.57 - 60.5）。
SWI上的ITSS分级与STB术后出血大小相关。
