Knauth M, Wirtz C R, Tronnier V M, Staubert A, Kunze S, Sartor K
Abteilung Neuroradiologie, Ruprecht-Karls-Universität Heidelberg.
Radiologe. 1998 Mar;38(3):218-24. doi: 10.1007/s001170050345.
The main aim of our study was to find out whether the combined use of neuronavigation and intraoperative MRI can increase the rate of "complete tumor removal". The second aim was to characterize the different forms of surgically induced enhancement in order to differentiate them from residual tumor.
Surgery was performed in 18 patients with high-grade glioma. Using a neuronavigation device, the surgeons operated up to the point where they would otherwise have terminated surgery. Intraoperative MRI was then performed to determine whether residual enhancing had been left behind and to update the neuronavigation device. If necessary, feasible surgery was continued. On days 1-3 after surgery early postoperative MRI (1.5 T) was performed. The proportion of patients in whom the enhancing tumor was completely removed was compared with a series of 60 patients with glioblastoma multiforme, who had been operated on using neither neuronavigation nor intraoperative MRI. We also looked for and characterized different types of surgically induced enhancement.
Intraoperative MRI definitely showed residual tumor in 6 of the 18 patients and resulted in ambiguous findings in 3 patients. In 7 patients surgery was continued. Early postoperative MRI showed residual tumor in 3 patients and resulted in uncertain findings in 2 patients. The rate of patients in whom complete removal of enhancing tumor could be achieved was 50% at the time of the intraoperative MR examination and 72% at the time of the early postoperative MR control. The difference in proportion of patients with "complete tumor removal" between the groups who had been operated on using neuronavigation (NN) and intraoperative MRI (ioMRI) and those who had been operated on using only modern neurosurgical techniques except NN and ioMRI was statistically highly significant (Fisher exact test; P = 0.008). Four different types of surgically induced contrast enhancement were observed. These phenomena carry different confounding potentials with residual tumor.
Our preliminary experience with intraoperative MRI in patients with enhancing intraaxial tumors is encouraging. Combined use of neuronavigation and intraoperative MRI was able to increase the proportion of patients in whom complete removal of the enhancing parts of the tumor was achieved. Surgically induced enhancement requires careful analysis of the intraoperative MRI in order not to confuse it with residual tumor.
我们研究的主要目的是确定神经导航与术中磁共振成像（MRI）联合使用是否能提高“肿瘤完全切除”率。第二个目的是描述手术诱发强化的不同形式，以便将它们与残留肿瘤区分开来。
对18例高级别胶质瘤患者进行手术。使用神经导航设备，外科医生手术至通常会终止手术的程度。然后进行术中MRI，以确定是否有残留强化，并更新神经导航设备。如有必要，继续可行的手术。术后1 - 3天进行早期术后MRI（1.5T）检查。将强化肿瘤完全切除的患者比例与60例多形性胶质母细胞瘤患者进行比较，后者未使用神经导航和术中MRI进行手术。我们还寻找并描述了不同类型的手术诱发强化。
术中MRI明确显示18例患者中有6例存在残留肿瘤，3例结果不明确。7例患者继续手术。早期术后MRI显示3例患者有残留肿瘤，2例结果不确定。术中MR检查时强化肿瘤完全切除的患者比例为50%，早期术后MR检查时为72%。使用神经导航（NN）和术中MRI（ioMRI）进行手术的组与仅使用除NN和ioMRI之外的现代神经外科技术进行手术的组相比，“肿瘤完全切除”患者比例的差异具有高度统计学意义（Fisher精确检验；P = 0.008）。观察到四种不同类型的手术诱发对比增强。这些现象与残留肿瘤具有不同的混淆可能性。
我们对术中MRI用于轴内强化肿瘤患者的初步经验令人鼓舞。神经导航与术中MRI联合使用能够提高肿瘤强化部分完全切除的患者比例。对于手术诱发的强化，需要仔细分析术中MRI，以免将其与残留肿瘤混淆。
