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目的评估脑膜瘤栓塞后成像特征及磁敏感加权成像(SWI)是否可以显示肿瘤缺血。方法对16例病人(8例组织病理学显示缺血,8例无缺血)术前栓塞治疗前后的影像进行研究。确定每人整个肿瘤的层选择感兴趣区(slice-wiseROI),对比缺血组与非缺血组SW、表观扩散系数(ADC)、脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及疾病进展时间(TTP)图的直方图变量[均值、标准差(SD)、最小值、最大值、直方图宽度、模式及峰值]。将SWI直方图的变化与组织病理学特征关联。结果缺血组SWI信号强度呈下降趋势,而非缺血组却呈部分上升。在ADC图上呈现类似表现。PWI直方图上显示缺血组MTT增加;两组间的CBV并无显著差异。微出血与SWI直方图峰值有一定关系。结论 SWI上T2*加权MR对比剂的栓塞后改变很大程度上与脱氧血红蛋白水平及动脉血流变化有关。要点①血管内栓塞现在是颅内脑膜瘤的辅助疗法。②MRI用来评价栓塞效果。③非增强敏感加权MRI可以显示缺血与非缺血区域。④SWI影像的信号改变与扩散及灌注异常有关。⑤三维高分辨力SWI提供了评价缺血的新影像指标。
Objective To evaluate the imaging characteristics of meningeal embolism and whether magnetic resonance weighted imaging (SWI) can show tumor ischemia. Methods 16 patients (8 cases of histopathology showed ischemia and 8 cases of no ischemia) were studied before and after embolization. The slice-wise ROI of each tumor in each patient was determined. The SW, ADC, CBV, CBF, Histogram Variables [Mean, Standard Deviation (SD), Min, Max, Histogram Width, Mode and Peak] for mean transit time (MTT) and disease progression time (TTP) maps. Association of changes in SWI histograms with histopathological features. Results The signal intensity of SWI in the ischemic group showed a decreasing trend, but not in the non-ischemic group. A similar appearance is seen on the ADC plot. The PWI histogram showed an increase in MTT in the ischemic group; there was no significant difference in CBV between the two groups. Microbleeds have a relationship with the peak of the SWI histogram. Conclusions The post-embolic changes of T2 * -weighted MR contrast agents on SWI are largely related to deoxyhemoglobin levels and arterial blood flow changes. Points ① Endovascular embolization is now an adjunct to intracranial meningiomas. ② MRI used to evaluate the embolization effect. ③ non-enhanced sensitivity-weighted MRI can display ischemic and non-ischemic areas. ④ SWI image signal changes and diffusion and perfusion related. ⑤ three-dimensional high-resolution SWI provides a new image evaluation of ischemia indicators.