本文選題：磁共振波譜 + 熒光素鈉　； 參考：《瀘州醫(yī)學院》2014年碩士論文

【摘要】：目的：多體素磁共振波譜(proton magneticreso-nancespectroscopy,1H-MRS)是一種無創(chuàng)性研究活體正�；虿±斫M織代謝、生化改變以及化合物定量分析的檢查方法，它能鑒別正常腦組織和病灶區(qū)域的代謝物的濃度改變進而區(qū)分腫瘤的真實邊界。本研究即應用多體素磁共振波譜成像技術的特點來驗證熒光素鈉指導的腦膠質(zhì)瘤手術切除的準確性，探索能夠在較多保留神經(jīng)功能的前提下，全切腦膠質(zhì)瘤的手術治療方案。方法：回顧性分析瀘州醫(yī)學院附屬醫(yī)院神經(jīng)外科從2011年7月至2013年7月收治的幕上腦膠質(zhì)瘤成人患者共75例，75例腦膠質(zhì)瘤患者術前均進行增強MRI檢查，術前進行熒光素納皮試，術中在熒光素鈉染色下嚴格按照熒光素鈉染色范圍手術切除腫瘤，若腫瘤不染色或者染色不明顯的，不能按照熒光素鈉染色范圍切除腫瘤，則按照傳統(tǒng)方法根據(jù)腫瘤與正常腦組織的質(zhì)地差異，結合術前影像學檢查經(jīng)驗性切除腫瘤。術中熒光素鈉染色滿意并嚴格按照染色范圍切除腫瘤的患者術后進行MRS檢查，并測量其術后術腔壁區(qū)（a區(qū)，術腔壁1cm以內(nèi)）、腫瘤側瘤旁腦組織區(qū)(b區(qū)，在T1WI、T2WI成像信號未見異常且無異常強化)及健側腫瘤相應區(qū)域正常腦組織（c區(qū)）的Cho/Cr（膽堿/肌酸）比值，統(tǒng)計學分析比較3區(qū)Cho/Cr的差異。結果：術中腫瘤熒光素鈉不染色或者染色不明顯者25例，此25例腦膠質(zhì)瘤病理結果為毛細胞型星形細胞瘤（WHO I級）3例，少突星形細胞瘤（WHO II級）3例，彌漫性星形細胞瘤（WHO II級）19例，術中只能經(jīng)驗性切除；術中腫瘤熒光素鈉染色滿意者50例，此50例患者病例結果為間變性少突膠質(zhì)細胞瘤（WHO III級）3例，間變性星形細胞瘤（WHO III級）19例，膠質(zhì)母細胞瘤（WHOIV級）28例，術中嚴格按照染色范圍切除，術后MRS測得三區(qū)的Cho/Cr比值以ˉx±s表示，分別為a區(qū)1.72±0.35，b區(qū)0.94±0.21，，c區(qū)0.92±0.22。在熒光素鈉染色滿意并嚴格按照染色范圍切除腫瘤的高級別腦膠質(zhì)瘤中，先采用完全隨機設計資料的方差分析比較3區(qū)的Cho/Cr比值，p0.05,差異有統(tǒng)計學意義，說明a、b、c3區(qū)不完全相同；再用方差分析中的q檢驗兩兩比較3區(qū)Cho/Cr比值差異，b區(qū)與c區(qū)p0.05，差異無統(tǒng)計學意義，說明b區(qū)與c區(qū)一樣，都屬于正常腦組織，a區(qū)分別與b區(qū)及c區(qū)比較，均為p0.05，差異有統(tǒng)計學意義，說明a區(qū)與b區(qū)及c區(qū)不同，為異常腦組織。結論：1、在低級別腦膠質(zhì)瘤手術中腫瘤在熒光素鈉染色下不顯色或者顯色不明顯，不能按照染色范圍切除腫瘤，故熒光素鈉在低級別腦膠質(zhì)瘤手術中的指導價值有限。2、在高級別膠質(zhì)瘤手術中，嚴格按照熒光素納的染色范圍切除腫瘤，腫瘤不能夠被完全切除，需擴大切除范圍，但具體需要擴大切除多少，有待進一步研究。
[Abstract]:Objective: magnetic resonance spectroscopy (MRS) of multivoxel magnetic resonance spectroscopy (MRS) is a noninvasive method for the study of normal or pathological tissue metabolism, biochemical changes and quantitative analysis of compounds in vivo. It can distinguish the change of metabolite concentration between normal brain tissue and lesion area and distinguish the true boundary of tumor. In this study, the characteristics of multivoxel magnetic resonance spectroscopy were used to verify the accuracy of surgical resection of gliomas guided by sodium fluorescein. Methods: 75 adult patients with supratentorial glioma admitted from July 2011 to July 2013 in Neurosurgery Department affiliated to Luzhou Medical College were examined with enhanced MRI before operation. During the operation, the tumor was resected strictly according to the scope of fluorescein sodium staining under fluorescein sodium staining. If the tumor was not stained or stained clearly, the tumor could not be removed according to the scope of fluorescein sodium staining. According to the traditional method, according to the difference between tumor and normal brain tissue, combined with preoperative imaging examination, the tumor was resected empirically. Postoperative MRS examination was performed in patients who were satisfied with fluorescein sodium staining and had been resected strictly according to the staining range. The area of luminal wall, the area of 1cm, and the area of brain tissue adjacent to the tumor were measured. The ratio of Cho / Cr (choline / creatine) in normal brain tissue of normal brain tissue in T _ 1WI _ I _ T _ 2WI and normal brain tissue of normal brain tissue in the corresponding region of contralateral tumor was statistically analyzed and compared with the difference of Cho/Cr in the three regions. Results: tumor fluorescein sodium was not stained or stained significantly in 25 cases during the operation. The pathological results of 25 cases of glioma were as follows: 3 cases of hair cell astrocytoma, 3 cases of WHO grade I, 3 cases of oligodendroid astrocytoma, 3 cases of WHO grade II. There were 19 cases of diffuse astrocytoma with WHO grade II, which could only be resected empirically during the operation, 50 cases were satisfied with fluorescein sodium staining during the operation, and 3 cases were diagnosed as anaplastic oligodendrocytoma with WHO grade III. 19 cases of anaplastic astrocytoma with III grade and 28 cases of glioblastoma with WHOIV grade were resected strictly according to the staining range during operation. The Cho/Cr ratio of the three zones measured by MRS after operation was expressed as X 鹵s, which was 1.72 鹵0.35b area 0.94 鹵0.21mc area 0.92 鹵0.2222 respectively. In the high-grade gliomas with satisfactory fluorescein sodium staining and strictly according to the range of staining, the Cho/Cr ratio (p0.05) of the three regions was compared by ANOVA of complete random design data. The difference was statistically significant. The Q test of ANOVA was used to compare the difference of Cho/Cr ratio between region b and area c (p 0.05), which indicated that area b and area c belong to normal brain tissue, which were compared with those of area b and area c, respectively. The difference was statistically significant, indicating that area a was different from area b and area c and was abnormal brain tissue. Conclusion: in the low-grade glioma surgery, the tumor does not show color under fluorescein sodium staining, and cannot be resected according to the range of staining. Therefore, the guiding value of sodium fluorescein in low-grade glioma surgery is limited. In high-grade glioma surgery, the tumor should be resected strictly according to the range of fluorescein staining. However, the specific need to expand the number of excision, to be further studied.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R739.4

【參考文獻】

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1 徐容;繆飛;吳志遠;倪根雄;尚寒冰;趙衛(wèi)國;;多體素~1H-MRS對星形細胞腫瘤邊界診斷的研究[J];放射學實踐;2010年04期

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