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首页> 外文期刊>Photodiagnosis and Photodynamic Therapy >Comparison of intraoperative fluorescence and MRI image guided neuronavigation in malignant brain tumours, a prospective controlled study
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Comparison of intraoperative fluorescence and MRI image guided neuronavigation in malignant brain tumours, a prospective controlled study

机译：术中荧光和MRI图像指导的神经导航在恶性脑肿瘤中的比较，一项前瞻性对照研究

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Introduction: MBT carry poor prognosis and more than 80% of MBT recur locally within 2 cm of the resection margin because of inadequate surgical removal. A number of techniques have been implemented in recent years to improve surgical removal of MBT with variable success. We examined two methods commonly used to resect MBT to establish which one offered the best chances of gross total removal; MRI guided technology and ALA-induced fluorescence. Patients and methods: Twenty consecutive patients diagnosed with MBT were included in this study. They were given 20 mg ALA per kg body weight 3 h before anaesthesia orally mixed in water. Surgery was planned using preoperative enhanced MPR age images. Surgery was executed using the Stealth Station image guidance system and ALA-induced fluorescence microsurgical techniques. During surgery the intensity of fluorescence was graded into red, pink or blue. The intensity of fluorescence was also measured using pulsed 405 nm laser and a compact spectrometer using a touch probe directly placed on the tissue. The extent of tumour invasion was assessed intraoperatively using standard white light, blue light and spectroscopic measurements. Postoperative enhanced MRI was used to assess the extent of resection and the volume of residual tumour was measured. Results: There were six newly diagnosed GBM, eight recurrent GBM, one oligodendroglioma (ODG) and five metastases (MET). On enhanced MRI, the mean diameter of new GBM, recurrent GBM, ODG and MET was 2.3 cm, 2.3 cm, 1.5 cm, and 2.3 cm respectively. Under the blue light, the mean diameter of new GBM, recurrent GBM, ODG and MET was 2.9cm, 3 cm, 1.5 cm and 2.3 cm respectively. The results of quantitative measurements of fluorescence ratios revealed that red fluorescence corresponded to 5.9-11.6 (solid tumour on histology), and pink fluorescence measured 0.8-1.9 (infiltrating edge of tumour on histology). When we compared the maximum tumour diameter of GBM we found on average it was 10 mm wider on spectroscopy compared to standard white light microscopy and 6 mm wider than what the enhanced MRI demonstrated. Conclusions: Fluorescence technology revealed that GBMs are wider than the enhanced MRI had demonstrated, while MET enhanced MRI was similar in size to fluorescence. Furthermore, solid tumour can be identified intraoperatively and can be measured using fluorescence and spectroscopy techniques and it can be removed safely. Infiltrating tumour can also be identified intraoperatively using this technology and can be removed in non-eloquent areas to maximise surgical resection.
机译：简介：MBT预后较差，由于手术切除不充分，超过80％的MBT在切除边缘2 cm内局部复发。近年来，已经采取了许多技术来提高MBT的手术切除率并取得不同的成功。我们检查了两种通常用于切除MBT的方法，以确定哪种方法提供了最佳的总清除率； MRI引导技术和ALA诱导的荧光。患者和方法：本研究包括连续20例诊断为MBT的患者。在麻醉前将其口服水混合3小时，给予每公斤体重20 mg ALA。使用术前增强的MPR年龄图像计划手术。使用隐形站图像引导系统和ALA诱导的荧光显微外科技术进行手术。在手术过程中，荧光强度分为红色，粉红色或蓝色。还使用脉冲405 nm激光和紧凑型光谱仪（使用直接放置在组织上的接触式探针）测量荧光强度。术中使用标准白光，蓝光和分光光度法评估肿瘤的侵袭程度。术后采用增强MRI评估切除范围并测量残留肿瘤的体积。结果：新诊断为GBM 6例，复发性GBM 8例，少突胶质细胞瘤（ODG）1例，转移灶（MET）5例。在增强MRI上，新GBM，复发性GBM，ODG和MET的平均直径分别为2.3 cm，2.3 cm，1.5 cm和2.3 cm。在蓝光下，新的GBM，复发性GBM，ODG和MET的平均直径分别为2.9cm，3cm，1.5cm和2.3cm。荧光比率的定量测量结果表明，红色荧光对应于5.9-11.6（组织学上的实体瘤），粉红色荧光对应0.8-1.9（组织学上的肿瘤浸润边缘）。当我们比较GBM的最大肿瘤直径时，我们发现在光谱学上它平均比标准白光显微镜宽10毫米，比增强MRI所显示的宽6毫米。结论：荧光技术表明，GBM比增强的MRI所显示的宽，而MET增强的MRI的大小与荧光相似。此外，可以在术中鉴定出实体瘤，并可以使用荧光和光谱技术对其进行测量，并且可以安全地将其切除。浸润的肿瘤也可以在术中使用该技术进行识别，并且可以在非雄性区域切除以最大化手术切除率。

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