MSCT与MRI在脑膜瘤诊断及手术入路评估中的临床应用价值

目的分析脑膜瘤的CT及MRI特征,评估CT及MRI在脑膜瘤术前定位、定性诊断及制定手术方案中的价值。方法回顾性分析经手术病理证实的27例脑膜瘤患者的CT及MRI资料,并与手术及术后病理结果对照。结果 27例脑膜瘤患者,MSCT平扫诊断率70.37%,MSCTA清晰显示肿瘤相邻的动脉与骨性解剖标志之间的三维关系;MRI平扫27例定位为颅内脑实质外肿瘤;MRI增强扫描诊断率96.30%,其中15例静脉窦旁脑膜瘤清晰显示肿瘤与静脉窦的相邻关系及静脉窦受压闭塞程度。依据MRI增强扫描及MSCTA定位诊断结果制定手术入路及方式,其中1例鞍旁脑膜瘤包绕颈内动脉虹吸部,另1例视神经管区域脑膜瘤包埋视神经部分予以残留;2例与矢状窦关系密切行脑膜瘤大部切除;余23例脑膜瘤完全切除。术后均无明确偏瘫、失明、失语等神经系统医源性损害症状。术后观察或随访1~24个月,无死亡病例。结论CT及MRI在脑膜瘤诊断、评估手术入路、保护肿瘤相邻动脉及静脉窦、减少医源性神经功能损害方面有重要价值。

Clinical application value of MSCT and MRI for the diagnosis of meningioma and assessment of operative approach

Objective To analyze CT and MRI characteristics of meningioma and estimate the values of CT and MRI in preoperative localization,qualitative diagnosis and establishing surgical planning for meningioma.Methods The CT and MRI data of 27 patients with meningioma confirmed by operation and pathology were analyzed retrospectively and compared with operation and postoperative pathological results. Results The diagnosis rate of multidetector-row spiral computed tomography（MSCT） scan was 70. 37% in 27 cases of meningioma. MSCT angiography（MSCTA） could clearly display the three-dimensional relation between adjacent artery of tumor and bony anatomical landmarks. The tumors of 27 cases were all positioned in the intracranial and extra-parenchyma by MRI scan. The diagnosis rate of contrast enhanced MRI（CE-MRI） scan for 27 cases was 96.30%,and in 15 cases of them with para-venous sinus meningioma,the adjacent relation between tumor and venous sinus and the occlusive degree of venous sinus duo to compression were display clearly. Based on the results of positioning diagnosis of CEMRI and MSCTA,the planning of operative route and method was made. The residuary lesions surrounding siphon part of internal carotid artery in one case of para-saddle meningioma and the residuary lesions embedding optic nerve in one case of the meningioma of optic canal region were not eliminated in operation; the meningioma subtotal excisions were performed because of its closed relation with sagittal sinus in two cases; the meningioma total resections were performed in the rest 23 cases. There were no definite iatrogenic damages of nervous system after operation such as hemiparalysis,blandness and aphasia etc. The observed or followed up period after operation was from 1 to 24 months,and no death case was seen. Conclusions CT and MRI have important values in the diagnosis of meningioma,assessing operative approach,protecting adjacent with tumor arteries and venous sinus and reducing iatrogenic damages of nervous function.