颅内多发病灶的立体定向活检术后病理学结果与MRS结果的比较分析

目的探讨立体定向活检术及磁共振波谱成像（MRS）在颅内多发病灶定性诊断中的临床价值。方法回顾性分析37例经MRI、MRS和立体定向活检术后病理学检查确诊的颅内多发病灶患者的临床资料,其中行有框架定向活检术22例,无框架神经导航定向活检术15例。结果 37例均获得明确病理学诊断,其中低级别胶质瘤19例,高级别胶质瘤8例,淋巴瘤3例,多发脱髓鞘3例,炎性病灶2例,转移癌2例。术后出现癫痫发作1例,活检靶点少量出血1例。病理学诊断与MRS诊断符合率为83.8%（31/37）,误诊率为16.2%（6/37）。结论 MRS在颅内多发病灶的诊断中具有较高的准确性,但仍有一定的误诊率;立体定向活检术微创、安全,在颅内多发病灶的诊断中具有决定性的意义;MRS的代谢变化在活检术靶点选择上具有一定的指导价值。

Stereotactic biopsy for multiple intracranial lesions and comparison between biopsy pathology and MRS diagnoses

Objective To investigate the clinical values of the stereotactic biopsy and MR spectroscopy （MRS） to the diagnosis of the multiple intracranial lesions （MICL）. Methods The clinical data of 37 patients with MICL undergoing stereotactic biopsy and MRS examination were analyzed retrospectively. Of 37 patients with MICL, 22 underwent framework stereotactic biopsy and 15 frameless neuronavigation biopsy. The diagnoses made by biopsy pathology were compared to those made by MRS imaging. Results The pathological diagnoses were made in all the patients with MICL, which included 19 cases of low grade gliomas, 8 high grade gliomas, 3 lymphomas, 3 multiple demyelinations, 2 inflammatory foci and 2 metastatic craninoma. MRS diagnosis coincidence rate with the pathological diagnosis was 83.7% （31/37）. MRS misdiagnostic rate was 16.2% （6/37）. Epilepsy occurred in 1 patient and a little amount hemorrhage occurred in the target of 1 patient after the biopsy. Conclusions The diagnosis of most MICL may be definitely made by MRS, but a few MICL may be misdiagnosed by MRS. All the MICL may be definitely made by minimally invasive and safe stereotactic biopsy. The metabolic changes showed by MRS is of a certain guiding value to biopsy target selection.