4D-CTA联合CTP在紧邻大血管脑膜瘤术前评估中的价值
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摘要
目的探讨320排CT4D-CTA联合全脑灌注CTP技术在脑膜瘤术前评估中的价值及优势。方法对拟诊为脑膜瘤的9例患者采用320排CT全脑灌注容积扫描一站式检查,一次扫描可获得平扫、多期增强图像,经后处理得到CTP图像、血管与灌注融合图像,经过切割方法进行数据信息提取和重建,然后模拟瘤体实体大小,提取瘤体并与血管融合。观察并评价脑膜瘤大小、形态,瘤体血流灌注情况及其与邻近血管关系,利用后处理图像为外科手术制定手术预案。结果共9例患者成功完成全脑灌注容积扫描;3D-CTP图像可以显示肿瘤异常灌注区。脑膜瘤和正常脑组织之间CBF和CBV存在显著差异。4D-CTA显示了脑膜瘤的供血和引流静脉。共6例患者成功实施手术,其中纤维型脑膜瘤4例,上皮细胞型脑膜瘤2例;余3例患者未进行手术。结论 4D-CTA联合CTP技术可以准确反映脑膜瘤血供情况,为完善手术方案、指导手术提供重要依据,对肿瘤的精准切除、减少术中出血及损伤有较大的指导意义。
Objective To investigate the value and advantages of 4 D-CTA combined with whole brain perfusion CTP technique by 320 row CT in preoperative evaluation of meningiomas adjacent to large vessels. Methods A total of 9 patients with suspected meningioma were examined by 320 row CT in whole brain perfusion volume scanning. Plain scan and multi-phase enhanced images can be obtained by one scan. By postprocessing, CTP images, blood vessels and perfusion or fusion images were obtained. After cutting, data information was extracted and reconstructed, then the size of tumor is simulated, and the tumor is extracted and fused with blood vessel. The size and shape of meningioma, the blood perfusion and its relation with adjacent vessels were observed and evaluated. Surgical plans were made for the surgeons by post-processing images. Results A total of 9 patients accepted the whole brain perfusion volume scan successfully. Abnormal perfusion areas were identified on 3 D-CTP maps. Significant differences in CBF and CBV were detected between meningioma and normal brain tissues. The blood supplying and draining veins of the tumor could be observed on 4 D-CTA images in 9 cases, and 6 patients underwent successful surgery, including 4 cases of fibrous meningioma and 2 cases of epithelial meningioma, while the other 3 patients had not undergone surgery. Conclusion 4 D-CTA combined with CTP technology can reflect the meningioma blood supply accurately, can guide the surgeon to improve the operation plan effectively, which has great guiding significance for accurate resection of tumors and reduce intraoperative bleeding and injury.
Objective To investigate the value and advantages of 4 D-CTA combined with whole brain perfusion CTP technique by 320 row CT in preoperative evaluation of meningiomas adjacent to large vessels. Methods A total of 9 patients with suspected meningioma were examined by 320 row CT in whole brain perfusion volume scanning. Plain scan and multi-phase enhanced images can be obtained by one scan. By postprocessing, CTP images, blood vessels and perfusion or fusion images were obtained. After cutting, data information was extracted and reconstructed, then the size of tumor is simulated, and the tumor is extracted and fused with blood vessel. The size and shape of meningioma, the blood perfusion and its relation with adjacent vessels were observed and evaluated. Surgical plans were made for the surgeons by post-processing images. Results A total of 9 patients accepted the whole brain perfusion volume scan successfully. Abnormal perfusion areas were identified on 3 D-CTP maps. Significant differences in CBF and CBV were detected between meningioma and normal brain tissues. The blood supplying and draining veins of the tumor could be observed on 4 D-CTA images in 9 cases, and 6 patients underwent successful surgery, including 4 cases of fibrous meningioma and 2 cases of epithelial meningioma, while the other 3 patients had not undergone surgery. Conclusion 4 D-CTA combined with CTP technology can reflect the meningioma blood supply accurately, can guide the surgeon to improve the operation plan effectively, which has great guiding significance for accurate resection of tumors and reduce intraoperative bleeding and injury.
引文
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[11]张荣伟,许峰,袁绍纪.320层CT对窦旁脑膜瘤瘤周水肿的灌注研究[J].中华神经外科疾病研究杂志,2013,12(2):142-145.
[12]殷长江,张荣伟.320排CTP及CTA对窦旁脑膜瘤瘤周水肿发生机制及其临床应用价值的研究[J].中华神经医学杂志,2016,15(9):896-900.
[13]张永生,李威.脑膜瘤患者应用C T灌注成像诊断及对脑膜瘤分型价值研究[J].中国CT和MRI杂志,2016,14(1):27-30.
[2]Chen T,Guo D,Fang Z,et al.Preliminary study of whole-brain CTperfusion imaging in patients with intracranial tumors adjacent to large blood vessels[J].Clin Radiol,2014,69(1):25-32.
[3]张荣伟,许峰,袁绍纪,等.320排CT血管造影对窦旁脑膜瘤显微手术的指导意义[J].中华神经医学杂志,2011,10(1):80-83.
[4]Marosi C,Hassler M,Roessler K,et al.Meningioma[J].Oncology,2008,67(2):153-171.
[5]付永春,周剑,刘巍.脑膜瘤术后并发症的相关影响因素分析[J].实用放射学杂志,2015,31(6):894-897.
[6]方钦锐,段传志,何旭英,等.颅底高血运脑膜瘤外科手术前栓塞术-有效性及安全性[J].介入放射学杂志,2016,25(5):400-403.
[7]段天鹏,尹建军.全脑CT灌注成像诊断邻近大血管颅内肿瘤[J].现代肿瘤医学,2017,25(3):0456-0458.
[8]孟盈盈,罗泽斌,夏俊,等.320排CT全脑灌注及4-D血管成像在颅脑的的临床应用进展[J].中国CT和MRI杂志,2015,13(2):113-117.
[9]Granata F,Morabito R,Alafaci C,et al.Perfusion computed tomography of intracranial meningiomas:In vivo correlation of cerebral blood volume and vascular permeability[J].Neuroradiol J,2015,28(3):303-309.
[10]凌华威,丁蓓,张欢,等.CT灌注成像对脑膜瘤诊断分型的临床价值[J].临床放射学杂志,2006,25(3):209-212.
[11]张荣伟,许峰,袁绍纪.320层CT对窦旁脑膜瘤瘤周水肿的灌注研究[J].中华神经外科疾病研究杂志,2013,12(2):142-145.
[12]殷长江,张荣伟.320排CTP及CTA对窦旁脑膜瘤瘤周水肿发生机制及其临床应用价值的研究[J].中华神经医学杂志,2016,15(9):896-900.
[13]张永生,李威.脑膜瘤患者应用C T灌注成像诊断及对脑膜瘤分型价值研究[J].中国CT和MRI杂志,2016,14(1):27-30.