听神经瘤MR影像学特点与术后残留相关性分析

要：目的探讨听神经瘤术前MR影像学特点与经乙状窦后入路术后残留的相关性。方法回顾性分析首都医科大学附属北京天坛医院神经外科2018年5月~2018年10月收治的124例采用经乙状窦后入路手术治疗，病理报告为神经鞘瘤的患者术前及术后的临床及MR影像学资料。根据术后是否存在病灶残留分为残留组及无残留组。影像征象包括侧别、肿瘤大小、囊实性、内听道T2WI 是否可见脑脊液信号影、是否存在周围水肿、是否压迫邻近脑组织等因素并与术后残留进行相关性分析。结果单因素分析显示两组之间性别、年龄、侧别、肿瘤大小、囊实性、是否压迫邻近脑组织之间的差异均无统计学意义（P＞0.05）；内听道T2WI 是否可见脑脊液信号影、是否存在周围水肿组间差异存在统计学意义，是术后病灶残留的影响因素（P＜0.05）。多因素分析结果显示内听道T2WI无脑脊液信号影（OR=3.617，95%CI=1.330~9.838，P=0.012）及存在周围组织水肿（OR=0.293，95%CI=0.111~0.774，P=0.013）为术后残留的独立危险因素。结论内听道无脑脊液信号影及存在周围组织水肿为术后病灶残留的独立危险因素。对于以上两点，可通过术前影像学检查对其具体情况进行充分评估，同时制定相应的手术方案，从而减少术后残留，改善患者预后。

Correlation analysis between MRI features and postoperative residual of acoustic neuroma

ObjectiveTo explore the correlation between preoperative MRI findings and postoperative residual of acoustic neuromas after surgery via retrosigmoid approach.MethodsClinical and MRI data of 124 patients suffering from acoustic neuroma surgically treated via retrosigmoid approach between May 2018 and Oct. 2018 in our department were analyzed retrospectively. Postoperative pathology confirmed acoustic neuroma in all the patients. All the patients were divided into groups with residual and without residual according to the postoperative examination results. The preoperative MRI findings included side and size of tumor, nature of tumor (cystic or solid), residual cerebrospinal fluid signal on T2WI, peripheral edema and compression of adjacent brain tissue. The correlations between the above mentioned MRI findings and postoperative residual were analyzed.ResultsUnivariate analysis showed that there were no significant differences between the two groups in patients’ gender and age, side and size as well as nature of tumor, compression of adjacent brain tissue (all P>0.05). There were significant differences between the two groups in cerebrospinal fluid signal and peripheral edema on T2WI of internal auditory canal (both P<0.05), which indicated that both were influencing factors of postoperative residual. Multivariate analysis showed that T2WI without CSF signal (OR=3.617, 95% CI=1.330-9.838, P=0.012) and presence of surrounding tissue edema (OR=0.293, 95% CI=0.111-0.774, P=0.013) were independent risk factors for postoperative residue.ConclusionsThe absence of CSF signal in the internal auditory canal and the presence of edema in surrounding tissues in preoperative MRI are independent risk factors for tumor residue. The above two points can be fully evaluated by preoperative imaging examination, and the corresponding surgical program can be formulated to reduce postoperative residue and improve the prognosis of patients.