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背景与目的:既往研究表明脑胶质瘤瘤周水肿(peritumoral brain edema,PTBE)是胶质瘤细胞侵袭的实际范围,PTBE的程度可作为脑胶质瘤的预后判断指标之一。然而,初诊时胶质瘤PTBE特征对全切术后肿瘤复发模式的影响目前还不详。本研究旨在探索初诊的脑胶质瘤MRI影像上的PTBE特征对全切术后肿瘤复发部位趋向及形态的影响。资料与方法:收集来自4个临床中心的43例全切术后复发的脑胶质瘤病例的MRI影像资料,回顾性分析初诊时MRI影像的T2加权像所示的PTBE的程度、类型与全切后复发肿瘤形态及部位趋向性的关系。结果:肿瘤全切术后复发模式与初诊脑胶质MRI影像的瘤周水肿特征明显相关:初诊时PTBE程度轻的在复发形态上更倾向局灶状(5/6),复发的生长趋向类型上更趋向于原位(4/6);水肿程度重的,复发形态趋向于扩散状(30/37),生长趋向类型多为周边型(7/37)、拓展型(27/37)。初诊时PTBE为类圆型的肿瘤复发以局灶状为多见(6/8),复发趋向多数为原位型(5/8),其次为周边型(2/8)和拓展型(1/8);水肿为不规则的肿瘤复发趋向绝大多数为拓展型(26/35),其次为周边型(7/35),少见原位型(2/35)。结论:胶质瘤PTBE的程度、类型对肿瘤全切术后复发形态、趋向性有显著的影响。这一发现有助于通过初诊脑胶质瘤的MRI的PTBE特征来个体化制订首次脑胶质瘤手术切除范围及术后放疗靶区,提高脑胶质瘤的临床疗效。
BACKGROUND & AIM: Previous studies have shown that peritumoral brain edema (PTBE) is the actual range of glioma cell invasion. The degree of PTBE can be used as one of the prognostic indicators of glioma. However, the initial diagnosis of glioma PTBE characteristics of tumor recurrence after resection of the impact of the pattern is not yet known. The aim of this study was to explore the effect of PTBE features on MRI findings of newly diagnosed gliomas on tumor recurrence site orientation and morphology after total resection. Materials and Methods: MRI data of 43 patients with totally resected gliomas collected from 4 clinical centers were collected. The degree, type and completeness of PTBE indicated by T2 weighted images of MRI images at first visit were retrospectively analyzed The Relationship Between the Morphology and Location Trend of Recurrent. Results: The pattern of tumor recurrence after total resection was significantly associated with the characteristics of peritumoral edema in newly diagnosed gliomas. The first diagnosis of PTBE was more prevalent in recurrence (5/6), and the type of the recurrence (4/6). The degree of edema was heavy, the recurrence pattern tended to diffuse (30/37), and the growth trend types were peripheral (7/37) and extension (27/37). At the first visit, tumors with round-like tumors were more common (6/8) with recurrences of mostly in situ (5/8), followed by peripheral (2/8) and expanded / 8). The majority of edematous tumor recurrences were extended type (26/35), followed by peripheral type (7/35) and rare in situ type (2/35). Conclusion: The degree and type of PTBE in glioma have a significant effect on the recurrence morphology and tendency after total tumor resection. This finding will help to define the scope of first-line glioma resection and post-operative radiotherapy target and improve the clinical efficacy of glioma through the PTBE features of newly diagnosed gliomas.