MRI导向立体定向活检术在颅内病变诊断中的临床应用

目的 探讨MRI引导下立体定向活检手术在颅内病灶诊断中的临床应用价值。方法 64例颅内占位病变在核磁共振(MRI)引导下行立体定向活检手术,以获得病理诊断。结果 64例病人均取得病理诊断,活检成功率100%。其中星形细胞瘤24例(37.5%),脑转移瘤17例(26.6%),脑非化脓性感染12例(18.8%),非霍奇金淋巴瘤3例(4.7%),胶质细胞增生4例(6.2%),脑真菌病1例(1.5%),脑囊尾蚴病1例(1.5%),脑结核性病变2例(3.1%)。术后无一例出现严重并发症。结论 对于颅内疑难病变,核磁共振(MRI)引导下立体定向活检手术是一种可靠的诊断手段,因其定位准确,误差小,活检准确率高,并发症少的特点,具有一定的临床价值,为进一步诊疗提供理论依据。     

CT、MRI引导立体定向脑活检术的临床研究

目的评价CT或MRI引导立体定向活检术在确定脑深部病变的病理组织学诊断及选择适宜的治疗方法中的作用.方法采用计算机体层摄影(CT)或磁共振成像(MRI)引导立体定向技术对420例脑深部或脑主要功能区病灶进行了活检手术.其中男252例,女168例,年龄4.5～71岁,平均40.3岁.病变位于脑深部104例,鞍区82例,基底节区78例,三脑室后部50例,多发病灶48例,脑室内23例,小脑半球19例,脑干内14例,斜坡2例.CT引导手术386例,MRI引导手术34例.结果共有405例作出了病理诊断,活检总阳性率为96.43%,其中肿瘤359例(85.48%),炎性病变33例(7.86%),其他病变13例(3.10%).未作出病理诊断者15例(3.57%).共发生手术并发症7例(1.67%)出血5例(1.2%),癫痫1例,意识障碍1例.结论 CT或MRI引导的立体定向脑深部病变活检术是一种明确颅内占位病变的组织学诊断的可靠方法,并能为临床治疗方法的选择提供依据.     

1H-MRS引导脑立体定向活检术临床应用

目的 探讨分析1H-MRS引导脑立体定向活检术的临床应用价值。方法 2014年3月至2015年12月行颅内占位病变立体定向活检术28例,采用MRI和1H-MRS引导。结果 28例中,胶质瘤19例,淋巴瘤4例,脱髓鞘病变3例,结核瘤1例,炎症1例。MRI组阳性22例,阳性检出率为78.57%。1H-MRS组阳性28例,阳性检出率100.00%。1H-MRS组阳性检出率明显高于MRI组（P<0.05）。术后均行头颅CT复查,无颅内出血。术后均未出现手术并发症。结论 与MRI相比,1H-MRS引导脑立体定向活检术阳性检出率较高。     

非强化脑病变立体定向活检诊断影响因素分析

目的分析MRI检查非强化脑内病变立体定向活检诊断率的影响因素。方法对92例非强化脑内病变的患者行MRI引导的立体定向活检手术,总结其临床表现、病变特点、病理诊断及术后并发症,分析影响活检诊断率的因素。结果 77例获得明确的病理诊断,活检诊断率为83.7%,并发症发生率为2.2%,多因素Logistic回归分析提示浅部(皮层)病灶活检诊断率显著低于深部(非皮层)病灶(优势比(OR)为3.937;95%可信区间为1.224~12.662;P0.05),其他因素与活检诊断率无明显相关性。结论立体定向活检术有助于明确脑内非强化病变的病理性质。病灶深度对活检诊断率有显著影响,皮层病灶诊断率较低。     

MRI引导立体定向活检在颅内多发病变中的诊断价值(附10例报道)

目的探讨MRI引导立体定向活检术的准确性及其在颅内多发病变诊断中的应用价值。方法本组男8例,女2例,年龄15～59岁,活检前所有患者均行了CT和MRI检查,确定颅内有多发病变,但不能肯定病理性质。手术在局麻下安装德国产ZEPPELLIN高精度脑立体定向仪,通过1.5Tesla MRI扫描计算出靶点坐标后,进行立体定向活检。结果术后病理学诊断星形细胞瘤Ⅲ级5例,胶质母细胞瘤1例,转移性小细胞恶性肿瘤1例,非霍奇金淋巴瘤(B细胞性)1例,炎性疾病1例,另外1例未能获得阳性病理学诊断,手术阳性诊断率为90%。术后1例出现活检靶点处出血,余未见其它并发症。结论脑立体定向活检术是明确颅内多发病变组织病理学性质的有效方法,它具有定位准确,误差小,活检准确率高,并发症少的特点,具有一定的临床应用价值。     

脑内病变MRI定位立体定向活检术33例

目的 总结脑内病变MRI定位立体定向活检术的经验。方法 2005年1月至2014年9月收治33例临床诊断困难的脑内病变患者,其中幕上病变31例,幕下病变2例,颅内多发性病灶19例;均在MRI引导下行立体定向活检术。结果 病理学诊断结果示胶质瘤13例,非何杰金氏淋巴瘤4例,转移瘤1例,炎性病变6例,结核性肉芽肿3例,真菌感染2例,神经变性2例;不能明确诊断2例,考虑胶质细胞增生。本组阳性诊断率为94.1%（31/33）。术后发生取材区非症状性出血2例,症状性出血1例;死亡1例。结论 MRI定位立体定向活检术是脑内病变诊断的重要方法,有效提高疑难病例的病理诊断成功率。     

立体定向活检术在颅内无强化效应病变中的诊断价值

目的 探讨立体定向活检术在颅内无强化效应病变中的定性诊断价值.方法 对47例在MRI增强扫描中未见明显强化的颅内病变行立体定向活检,其中MRI引导有框架立体定向活检38例,无框架神经导航定向活检9例.结果 获得明确病理诊断42例,未获得阳性病理结果5例,活检病理诊断阳性率89.4％.对颅内非肿瘤性病变,MRI诊断与病理诊断相符合9例;对肿瘤性病变,MRI诊断与病理诊断相符合14例;MRI诊断与病理诊断的符合率为48.9％.活检术后穿刺道少量出血1例,无颅内感染和死亡病例.结论 对颅内无强化效应的病变,立体定向活检是获得定性诊断安全、可靠的方法.     

CT、MRI引导下立体定向颅内病变活检

目的探讨立体定向脑活检方法的可靠性和安全性,研究手术方法及技术要点。方法回顾性分析我院1999年6月至2005年11月,CT或MRI引导下立体定向活检47例。其中男32例,女15例。年龄18~83岁,平均年龄36.4±14.8岁。病灶位于:大脑半球25例,基底节及丘脑13例,鞍区6例,多发病变3例。结果活检病理诊断:星形细胞瘤I级22(46.8%),星形细胞瘤II级5例(10.6%),星形细胞瘤III级1例(2.1%),胶质母细胞瘤(IV级)3例(6.4%),炎性病变、转移瘤各3例(6.4%),颅咽管瘤、脑囊虫病各2例(4.3%),脑胶质瘤病、假瘤型炎性脱髓鞘病、结核瘤各1例(2.1%),胶质增生或未明确诊断3例(6.4%)。活检确诊率94.6%,无并发症发生。结论立体定向脑深部病灶活检技术安全、可靠,对临床诊断、鉴别诊断、治疗的选择及手术有重要的意义。     

《立体定向和功能性神经外科杂志》第19卷（2006）分类索引

颅内肿瘤伽玛刀治疗颅内多发脑膜瘤1例报告…袁树斌文武梁昕等(1):61MRI定位下立体定向活检术在颅内多发疑难病例诊断中的应用…黄文辉李俊德王进钢等(1):65影像学引导的立体定向活检在脑疾病诊断中的价值(附50例临床分析)…王学廉贺世明梁秦川等(2):70CT、MRI引导下立体定向颅     

微侵袭立体定向活检手术方法的研究

目的 研究应用微侵袭立体定向活检手术方法获取颅脑深部病变组织的可行性和准确性。方法 CT或MRI与立体定向技术相结合,对605例脑深部病变患者进行精确定位、活检,其中450例用CT或MRI目测靶点坐标定位,155例采用计算机辅助立体定向手术工作站,自动计算靶点坐标和规划活检手术入路。结果 活检手术后,经病理证实为脑肿瘤组织者537例(88.76％),炎性病变组织者30例(4.96％),其他病变组织18例(2.98％),另有20例(3.31％)未能提出可供病理学确诊的依据,阳性诊断率为96.69％。术后发生并发症13例(2.15％),死亡2例(0.33％)。结论 经影像学引导的立体定向活检手术是神经内外科获得颅脑深部病变定性诊断安全而可靠的方法,值得临床推广应用。     

影像学引导的立体定向脑活检手术

目的探讨现代神经成像技术(CT、MRI)引导的立体定向脑病变活检术对组织病理学诊断的可靠性和正确性,总结手术操作方法和技术要点。方法采用CT、MRI与立体定向技术相结合,进行脑部病变的活检手术共605例,其中450例用CT或MRI片目测靶点坐标定位,155例采用计算机辅助的立体定向手术(CAPN)工作站,自动计算靶点和规划活检入路。结果522例确诊为各种脑肿瘤,39例为炎性病理,23例为寄生虫或先天性囊肿,16例未能提供可供确诊的病理,阳性诊断率为97.36%。并发症15例,其中2例死亡。结论先进影像技术引导下的立体定向脑病变活检术是神经内、外科脑部病变获得定性诊断安全、可靠的手术方法。术中应注意改进操作方法,以提高病理诊断的阳性率,并达到微侵袭性手术的要求。     

Spectroscopy-supported frame-based image-guided stereotactic biopsy of parenchymal brain lesions: Comparative evaluation of diagnostic yield and diagnostic accuracy

Objective

Comparative evaluation of diagnostic efficacy of stereotactic brain biopsy performed with and without additional use of spectroscopic imaging (¹H-MRS) for target selection was done.

Methods

From 2002 to 2006, 30 patients with parenchymal brain lesions underwent ¹H-MRS-supported frame-based stereotactic biopsy, whereas in 39 others MRI-guided technique was used. Comparison of diagnostic yield of the procedure in these two groups was performed. Additionally, the diagnostic accuracy was evaluated in 37 lesions, which were surgically resected within 1 month thereafter.

Results

Stereotactic biopsy permitted establishment of a definitive histopathological diagnosis in 57 cases and diagnosis of low-grade glioma without specific tumor typing in 8 cases. In 4 cases tissue sampling was non-diagnostic. In 5 out of 8 cases with incomplete diagnosis and in all non-diagnostic cases target selection was performed without the use of ¹H-MRS (P = 0.2073). The diagnostic yields of ¹H-MRS-supported and MRI-guided procedures were 100% and 90%, respectively (P = 0.1268). Comparison of the histopathological diagnoses after stereotactic biopsy and surgical resection revealed complete diagnostic agreement in 13 cases, minor disagreement in 14 cases, and major disagreement in 10 cases. Among these last 10 cases, initial undergrading of non-enhancing WHO grade III gliomas was the most common (7 cases). The diagnostic accuracy of ¹H-MRS-supported and MRI-guided procedures was 67% and 79%, respectively (P = 0.4756).

Conclusion

While in the present study the diagnostic yield of ¹H-MRS-supported frame-based stereotactic brain biopsy was 100%, its statistically significant diagnostic advantages over MRI-guided technique were not proved. Optimal selection of the spectroscopic target for tissue sampling remains unclear.     

MRI-guided frame-based stereotactic brainstem biopsy procedure: A single-center experience

Introduction and objectivesThis study aims at presenting our experience of the MRI-guided frame-based stereotactic brainstem biopsy method, and evaluating the outcomes of the procedure.Patients and methodsThe current study involved 18 cases that underwent MRI-guided frame-based stereotactic biopsy for brainstem lesions between 2011 and 2018 in our clinic. The relevant data regarding the technique of the biopsy procedure, morbidity, histopathological diagnosis it yields and diagnostic accuracy was retrospectively analyzed.ResultsStereotactic biopsy procedure was performed on 18 patients, including 16 adults and two children. MRI was used as guidance for the biopsy procedure in all patients. The adult patients had the biopsy under local anesthesia; as for the pediatric patients local anesthesia plus sedation was used. All patients received diagnosis based on the histopathological examination of their biopsy samples. No equivocal or negative results, and no major morbidity or mortality was seen in the patients after the procedure.ConclusionsMRI-guided frame-based stereotactic biopsy can be considered as a safe and efficient diagnostic method for brainstem lesions when its diagnostic yield and its morbidity and/or mortality rates are evaluated. Choosing the best trajectory for each lesion, using MRI as guidance for targeting, taking a limited number of biopsy samples are valuable criteria for the decreased morbidity rates in stereotactic brainstem biopsy procedures.     

MRI 导向立体定向活检术在颅内病变诊断中的应用简

目的探讨MR／引导下立体定向活检手术在颅内病灶诊断的准确性、安全性及其临床应用价值。方法回顾性分析52例病变性质不明的颅内病变病人的临床资料,在MRI导向下行立体定向活检术。结果52例病人均取得病理诊断．活检成功率100％。星形细胞瘤20例（38．5％）,脑转移瘤13例（25．0％）,脑非化脓性感染10例（19．2％）,非霍奇金淋巴瘤4例（7．7％）,胶质细胞增生2例（3．8％）,脑真菌病、脑囊尾蚴病及结核性病变各1例（1．9％）。术后无一例出现严重并发症。除l例放弃治疗,其余病人转相应专科治疗。结论对于难以行开颅手术的颅内疑难病变,MRI导向立体定向活检手术可提供一种可靠的诊断手段,为临床进一步诊疗提供理论依据。     

MRI立体定向活检术在颅内病变诊断中的应用

目的 探讨MRI引导下立体定向活检术在颅内病变诊断中的作用价值。方法 自2009年1月至2015年3月应用立体定向系统与手术计划软件对25例颅内病变诊断不明确的患者行MRI定位下立体定向活检术。结果 除1例活检阴性外,病理诊断与最后诊断（结合临床和其他检查结果）一致20例,不一致4例;最后诊断与术前MRI诊断相符合8例,不符合9例,影像未诊断6例;切除术后病理与影像相符合1例,无明确关系1例。术后6例病变内少量出血,保守治疗;1例左额叶出血30 ml,行开颅血肿清除+去骨瓣减压术。结论 MRI立体定向活检术对颅内多发、深部病变的诊断具有重要价值,其安全性较高,但仍需进一步避免脑出血的风险。     

MRI定位下立体定向活检术在颅内多发疑难病例诊断中的应用

目的探讨MRI定位立体定向活检术的优点及其在颅内多发疑难病例诊断中的应用价值。方法安装Leksell-G型定位框架,采用MRI扫描,确定靶点的位置。对22例临床表现不典型或影像学上较难诊断的多发疑难占位患者施行立体定向活检手术。结果22例患者均未出现因活检手术造成的颅内出血、偏瘫等严重并发症。所有患者均得到明确的病理诊断及相应的治疗。结论MRI定位立体定向活检手术具有准确性高的优点,能够有效的诊断颅内多发疑难病例。     

Accuracy of frameless and frame-based image-guided stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy and open resection specimen

OBJECTIVES: Tissue heterogeneity and rapid tumor progression may decrease the accuracy a prognostic value of stereotactic brain biopsy in the diagnosis of gliomas. Correct tumor grading is therefore dependent on the accuracy of biopsy needle placement. There has been a dramatic increase in the utilization of frameless image-guided stereotactic brain biopsy; however, its accuracy in the diagnosis of glioma remains unstudied. METHODS: The diagnoses of 21 astrocytic brain tumors were derived using image-guided stereotactic biopsy (12 frame-based, nine frameless) and followed by open resection of the lesion 1.5 (0.5-4) months later. The histologic diagnoses yielded by the biopsy were compared with subsequent histologic diagnosis from open tumor resection. RESULTS: Histology of 21 stereotactic biopsies accurately represented the greater lesion at open resection a median of 45 days later in 16 (76%) cases and correctly guided therapy in 19 (91%) cases. Biopsy accuracy of frameless versus frame-based stereotaxis was similar (89 versus 66%, p=0.21). In three (14%) cases, biopsy specimens were adequate to diagnose glioma; however, histology was insufficient for definitive tumor grading. Anaplastic oligodendroglioma (ODG) was under-graded as low-grade ODG in one (5%) case. Biopsy of new onset glioblastoma multiforme (GBM) yielded necrosis/gliosis and was termed non-diagnostic in one patient. Tumors <50 cm(3) were 8-fold less likely to accurately represent the grade of the entire lesion at resection compared with lesions <50 cm(3) (OR, 8.8; 95% CI, 0.9-100, p=0.05). DISCUSSION: Both frameless and frame-based MRI-guided stereotactic brain biopsy are safe and accurately represent the larger glioma mass sufficiently to guide subsequent therapy. Large tumor volume had a higher incidence of non-concordance. Increasing the number of specimens taken through the long dimension of large tumors may improve diagnostic accuracy.     

The clinical utility of multimodal MR image-guided needle biopsy in cerebral gliomas

Purpose: Our aim was to evaluate the diagnostic value of multimodal Magnetic Resonance (MR) Image in the stereotactic biopsy of cerebral gliomas, and investigate its implications. Materials and Methods: Twenty-four patients with cerebral gliomas underwent ¹H Magnetic Resonance Spectroscopy (¹H-MRS)- and intraoperative Magnetic Resonance Imaging (iMRI)-supported stereotactic biopsy, and 23 patients underwent only the preoperative MRI-guided biopsy. The diagnostic yield, morbidity and mortality rates were analyzed. In addition, 20 patients underwent subsequent tumor resection, thus the diagnostic accuracy of the biopsy was further evaluated. Results: The diagnostic accuracies of biopsies evaluated by tumor resection in the trial groups were better than control groups (92.3% and 42.9%, respectively, p = 0.031). The diagnostic yield in the trial groups was better than the control groups, but the difference was not statistically significant (100% and 82.6%, respectively, p = 0.05). The morbidity and mortality rates were similar in both groups. Conclusions: Multimodal MR image-guided glioma biopsy is practical and valuable. This technique can increase the diagnostic accuracy in the stereotactic biopsy of cerebral gliomas. Besides, it is likely to increase the diagnostic yield but requires further validation.