MRI引导脑胶质瘤立体定向活检的准确性评价

目的：评价MRI引导脑胶质瘤立体定向活检的准确性及临床价值。方法：回顾性分析MRI引导立体定向活检及术后病理证实的50例脑胶质瘤患者的临床、MRI及病理学资料，比较MRI引导立体定向活检与术后病理学检查结果。结果：29例患者活检后2月内进行了手术，立体定向活检正确指导治疗28例（97％），活检与术后病理结果完全一致者24例（83％），恶性胶质瘤误诊为间变性星形细胞瘤4例，恶性胶质瘤误诊放射性脑坏死1例。21例患者于活检2个月后（平均6．5个月）进行了手术，7例活检胶质瘤分级与术后病理结果完全一致，而活检14例放射性脑坏死中仅5例（36％）符合术后病理诊断。结论：MRI引导胶质瘤立体定向活检能够充分代表整体肿瘤的病理学分级，可正确指导后续治疗，而肿瘤强化特征是活检潜在抽样误差的一个预测指标。

Diagnositic accuracy of MRI- guided brain stereotactic biopsy in gliomas

Objective： To evaluate the accuracy and clinical value of MRI - guided brain stereotactic biopsy in the management of gliomas. Methods： The diagnoses in 50 cases of brain giiomas were derived using MRI - guided stereotactic biopsy followed by open resection of the lesion. The histologic diagnoses yielded by biopsy were compared with subsequent histologic diagnosis after open tumor resection. Results ： In 29 patients undergoing resection 〈 60 days after biopsy,the biopsy diagnosis was consistent with resection diagnosis in 24 cases（ 83% ） and led to the correct treatment in 28 cases （97%）. Glioblastoma was undergraded as anaplastic astrocytoma in 4 cases. Glioblastoma was misdiagnosed as radiation necrosis in 1 case. In 21 patients undergoing resection 〉 2 months after biopsy（mean 6.5 months） ,7/7 （ 100% ） biopsy diagnoses of a specific glioma grade correlated with resection diagnosis ,while only 5/14 （36%） biopsy diagnoses of radiation necrosis correlated with resection diagnosis. Conclusion： MRI- guided stereotactic brain biopsy specimen accurately represents the grade of the larger glioma mass sufficiently to guide subsequent therapy. Enhancement on MR may be a prognostic indicator of potential biopsy sampling error.