...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Neurosurgical focus >Tumor detection with 5-aminolevulinic acid fluorescence and Gd-DTPA–enhanced intraoperative MRI at the border of contrast-enhancing lesions: a prospective study based on histopathological assessment
【24h】

Tumor detection with 5-aminolevulinic acid fluorescence and Gd-DTPA–enhanced intraoperative MRI at the border of contrast-enhancing lesions: a prospective study based on histopathological assessment

机译：用5-氨基乙酰丙酸荧光和Gd-DTPA增强的术中MRI在增强对比病灶的边界进行肿瘤检测：基于组织病理学评估的前瞻性研究

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Object High-grade gliomas (HGGs) and metastasis (MET) are the most common intracranial lesions in neurosurgical routine. Both of them show an invasive growth pattern extending into neural tissue beyond the margins of contrast enhancement on MRI. These “undetected” areas might be the origin of early tumor recurrence. The aim of the present study was to evaluate whether 5-aminolevulinic acid (5-ALA) fluorescence provides an additional benefit in detection of invasive tumor compared with intraoperative MRI (iMRI). Methods The authors prospectively enrolled 45 patients harboring contrast-enhancing lesions, in whom gross-total resection was intended. All patients had surgery in which iMRI and 5-ALA–guided resection were used following a specific protocol. First, a typical white light tumor resection was performed. Then, spatial location of residual fluorescence was marked. After that, an iMRI was performed and residual uptake of contrast was marked. Navigated biopsy samples were taken from all marked areas and from additional sites according to the surgeon's judgment. Cross tables and receiver operating characteristic curves were calculated, assessing performance of the imaging methods for tumor detection alone and for combined detection of infiltration zone and solid tumor (pathological tissue). Also, correlations of histopathological findings with imaging results were tested using Spearman rho. Results Thirty-four patients with HGGs and 11 with METs were enrolled. Three patients harboring a MET showed no 5-ALA enhancement and were excluded; 127 histopathological samples were harvested in the remaining patients. In HGG, sensitivity for tumor detection was significantly higher (p Conclusions In METs, due to the rate of nonenhancing lesions, the authors found no additional benefit of 5-ALA compared with iMRI. In HGG, imaging results of 5-ALA and iMRI are significantly different at the border zone; 5-ALA has a higher sensitivity and a lower specificity for tumor detection than Gd-DTPA–enhanced iMRI. For detection of infiltrating tumor at the border of the resection cavity, 5-ALA is superior to Gd-DTPA–enhanced iMRI concerning both sensitivity and specificity. Thus, use of 5-ALA in addition to iMRI might be beneficial to maximize extent of resection. Clinical synergistic effects will be evaluated in a prospective randomized trial.
机译：对象高级别神经胶质瘤（HGGs）和转移（MET）是神经外科常规手术中最常见的颅内病变。它们都显示出侵入性生长模式，延伸到神经组织，超出了MRI增强对比的范围。这些“未发现”的区域可能是早期肿瘤复发的起源。本研究的目的是评估与术中MRI（iMRI）相比，5-氨基乙酰丙酸（5-ALA）荧光是否在检测浸润性肿瘤方面具有其他优势。方法作者前瞻性纳入了45例行造影剂增强术的患者，他们打算行全切术。所有患者均接受手术，并按照特定方案使用了iMRI和5-ALA引导的切除术。首先，进行典型的白光肿瘤切除术。然后，标记残留荧光的空间位置。之后，进行了iMRI，并标出了剩余的造影剂摄取。根据外科医生的判断，从所有标记区域和其他部位采集导航活检样本。计算交叉表和接收器工作特征曲线，评估仅用于肿瘤检测以及用于联合检测浸润区和实体瘤（病理组织）的成像方法的性能。此外，使用Spearman rho测试了组织病理学发现与影像学结果的相关性。结果招募了34例HGG患者和11例MET患者。 3名携带MET的患者未表现出5-ALA增强，被排除在外。在其余患者中收集了127份组织病理学样品。在HGG中，肿瘤检测的敏感性显着更高（p结论在METs中，由于非增强病变的发生率，作者发现5-ALA与iMRI相比没有其他好处。在HGG中，5-ALA和iMRI的成像结果是在边界区域有显着差异; 5-ALA对肿瘤的检测比对Gd-DTPA增强的iMRI具有更高的灵敏度和更低的特异性;对于切除腔边界处的浸润性肿瘤，5-ALA优于Gd- DTPA增强了iMRI的敏感性和特异性，因此，除iMRI之外还使用5-ALA可能有利于最大程度地切除，将在一项前瞻性随机试验中评估临床协同作用。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号