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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Magnetic resonance imaging surveillance following vestibular schwannoma resection.
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Magnetic resonance imaging surveillance following vestibular schwannoma resection.

机译：前庭神经鞘瘤切除术后的磁共振成像监视。

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OBJECTIVES/HYPOTHESIS: To describe the incidence, pattern, and course of postoperative enhancement within the operative bed using serial gadolinium-enhanced magnetic resonance imaging (MRI) following vestibular schwannoma (VS) resection and to identify clinical and radiologic variables associated with recurrence. STUDY DESIGN: Retrospective cohort study. METHODS: All patients who underwent microsurgical resection of VS between January 2000 and January 2010 at a single tertiary referral center were reviewed. Postoperative enhancement patterns were characterized on serial MRI studies. Clinical follow-up and outcomes were recorded. RESULTS: During the last 10 years, 350 patients underwent microsurgical VS resection, and of these, 203 patients met study criteria (mean radiologic follow-up, 3.5 years). A total of 144 patients underwent gross total resection (GTR), 32 received near-total resection (NTR), and the remaining 27 underwent subtotal resection (STR); 98.5% of patients demonstrated enhancement within the operative bed following resection (58.5% linear, 41.5% nodular). Stable enhancement patterns were seen in 24.5% of patients, regression in 66.0%, and resolution in only 3.5% of patients on the most recent postoperative MRI. Twelve patients recurred a mean of 3.0 years following surgery. The average maximum linear diameter growth rate among recurrent tumors was 2.3 mm per year. Those receiving STR were more than nine times more likely to experience recurrence compared to those undergoing NTR or GTR (P < .001). Nodular enhancement on the initial postoperative MRI was associated with a 16-fold increased risk for future recurrence compared to those with linear patterns (P = .008). Among those with nodular enhancement on baseline postoperative MRI, a maximum linear diameter of >/= 15 mm or volume of >/= 0.4 cm(3) was associated with an approximate five-fold increased risk for future growth (P < .02). CONCLUSIONS: Persistent nonspecific radiologic enhancement within the postoperative field is common, making the diagnosis of tumor recurrence challenging. Factors including completeness of resection and baseline postoperative MRI findings provide valuable information regarding risk for recurrence, which may assist the clinician in determining an appropriate postoperative MRI surveillance schedule. Future studies using standardized terminology and consistent study metrics are needed to further refine surveillance recommendations.
机译：目的/假设：描述前庭神经鞘瘤（VS）切除后使用系列serial增强磁共振成像（MRI）在手术床上的发生率，模式和术后增强的过程，并确定与复发相关的临床和放射学变量。研究设计：回顾性队列研究。方法：回顾性分析了2000年1月至2010年1月间在单个三级转诊中心接受VS显微手术切除的所有患者。术后增强模式在系列MRI研究中进行了表征。记录临床随访和结果。结果：在过去的10年中，有350例患者接受了显微外科VS切除术，其中203例符合研究标准（平均影像学随访时间为3.5年）。共有144例患者接受了全切术（GTR），其中32例接受了近全切术（NTR），其余27例接受了全切术（STR）; 98.5％的患者在手术后的手术床上表现出增强（58.5％的线性，41.5％的结节性）。在最近的MRI检查中，稳定的增强模式在24.5％的患者中可见，在66.0％的患者中消退，在3.5％的患者中只有3.5％的患者消退。十二名患者术后平均复发3.0年。复发性肿瘤之间的平均最大线性直径增长率为每年2.3 mm。与接受NTR或GTR的患者相比，接受STR的患者发生复发的可能性高9倍以上（P <.001）。与线性模式相比，初始术后MRI结节性增强与未来复发风险增加了16倍（P = .008）。在基线术后MRI结节性增强的患者中，最大线性直径> / = 15 mm或体积> / = 0.4 cm（3）与未来生长的风险增加大约五倍有关（P <.02） 。结论：术后领域内持续的非特异性放射学增强是常见的，这使得诊断肿瘤复发具有挑战性。包括切除的完整性和术后基线MRI检查结果在内的因素为复发风险提供了有价值的信息，这可能有助于临床医生确定适当的术后MRI监测计划。需要进一步使用标准化术语和一致的研究指标进行研究，以进一步完善监视建议。

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