头颅磁共振成像引导幕上病变活检103例*

摘要: 目的探讨磁共振成像（magnetic resonance imaging，MRI）引导下微钻钻孔立体定向活检术在颅内占位性病变的应用。方法回顾性分析2009年11月至2013年12月就诊于首都医科大学三博脑科医院103例因脑幕上病变行MRI引导微钻钻孔立体定向活检手术的患者，分析病变的病理结果及患者术后情况。结果 102例患者均获取明确的病理诊断，活检阳性率99.0%，其中胶质瘤66例（65.0%），淋巴瘤27例（26.5%），横纹肌肉瘤1例（1.0%），生殖细胞肿瘤3例（2.9%），炎性病变3例（2.9%），脑灰质异位2例（2.0%），脑梗塞1例（1.0%）。3例患者术后出现穿刺部位出血（2.9%），1例（1.0%）需行手术清除血肿，无死亡病例，无术后感染病例。结论磁共振引导微钻钻孔脑立体定向活检术是一种安全、可靠、微创的手术方法，对颅内病变的诊断与治疗具有重要意义。
- 立体定位技术 /
- 脑疾病 /
- 活组织检查 /
- 磁共振成像
Abstract: Objective To evaluate the reliability and accuracy of MRI-guided stereotactic biopsy for supratentorial brain lesions. Method A total of 103 cases of MRI-guided biopsy were performed between November 2009 and December 2013. Patients' pathological results and postoperative rehabilitation courses were analyzed. Results A total of 102 patients (99.0%) had pathological results, of which 97 cases were brain tumors (86.0%), including 36 cases of astrocytoma, 9 cases of anaplastic astrocytoma, 10 cases of oligoastrocytoma, 4 cases of anaplastic oligoastrocytoma, 4 cases of anaplastic oligodendroglioma, 3 cases of glioblastoma multiforme, 27 cases of lymphoma, 3 cases of germ cell tumors, and 1 case of rhabdomyosarcoma. Inflammatory lesions were found in 3 cases (2.9%). Displacement of brain gray matter was reported in 2 cases (2.0%), and 1 case (1.0%) of cerebral infarction existed. A total of 3 patients suffered intracranial hematoma after biopsy, and 1 patient underwent craniotomy to remove the hematoma. No death or intracranial inflammation occurred after biopsy. Conclusion MRI-guided stereotactic biopsy is a safe and reliable method in qualitative diagnosis. It is a very important tool for diagnosis and treatment selection for intracranial lesions.
- stereotactic techniques /
- brain diseases /
- biopsy /
- magnetic resonance imaging

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图 1 患者女，56岁，因左偏身麻木1月入院。检查结果示原发中枢神经系统淋巴瘤，患者术后行系统化疗

Figure 1. A 56-year old female, with left side numbess for 1 month. Imaging examination showed primary central nervous system lymphoma. The patient received postoperative chemotherapy

A and B.Preoperative MR flair image; C and D. Preoperative enhancing image; E and F. Preoperative CT image; G: Biopsy image; H. Pathological section (H&E staining, ×100 magnification) showed of non-Hodgkin's and diffuse large B-cell lymphoma

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图 2 患者女，47岁，因左下肢乏力2个月入院。经治疗13个月后，MRI示肿瘤明显缩小

Figure 2. A 47-year old female patient was admitted to the hospital because of the left leg weakness for 2 months. She received sequential therapy for 13 months, and MRI showed the tumor significantly shrinked

A and B. Preoperative MR T2 image showed right thalamus lesion with high signal; C. Biopsy image; D and E. Preoperative enhancement image showed no enhancing; F. Pathological section (H&E staining, ×200 magnification) showed of anaplastic astrocytoma; G, H, and I. Postoperative T2 imaging results at 13 months after brain biopsy treatment followed by local radiotherapy and chemotherapy; J, K, and L. Postoperative enhancing MR images after 13 months, showing that the tumor significantly shrinked and the disease controlled well

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