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Relationship between the Enhanced MRI Features of Preoperative Brain Volume Imaging and Surgical Methods of the Glomus Jugulare Tumor
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摘要:
目的 探讨颈静脉球瘤(glomus jugulare tumor, GJT)患者术前MRI脑容积成像(brain volume imaging，BRAVO)增强影像特征与手术入路的关系。 方法 回顾性纳入2015年2月至2021年3月于北京协和医院行手术治疗的GJT患者。根据患者病历资料中记录的手术入路，将其分为颞下窝入路(infratemporal fossa approach，IFA)组、颞下窝联合入路(combined infratemporal fossa approach, CIFA)组。两组患者术前均行MRI检查，根据增强BRAVO序列影像特征确定肿瘤Fisch分型，并与术中确定的Fisch分型进行一致性比较。测量BRAVO序列图像横轴位肿瘤最大径、冠状位肿瘤最长径及脑膜侵犯宽度、脑膜侵犯深度，并进行组间比较。 结果 共25例符合纳入和排除标准的GJT患者入选本研究。其中IFA组16例(手术入路为颞下窝A型入路)、CIFA组9例(手术入路为颞下窝A型+B型入路)。影像C分型为C1型1例、C2型10例、C3型12例、C4型2例；影像D分型为De1型8例、Di1型6例、Di2型5例。除1例患者术前影像分型(C3型)与手术分型(C2型)不一致外，其余患者影像C、D分型与手术C、D分型均一致(Kappa=0.934，P＜0.001；Kappa=1.000，P＜0.001)。两组患者术前影像C分型(P=0.029)、D分型(P=0.006)均有显著性差异。CIFA组横轴位肿瘤最大径(P=0.013)、脑膜侵犯深度(P=0.003)、脑膜侵犯宽度(P=0.011)均大于IFA组，冠状位肿瘤最长径(P=0.125)与IFA组无显著性差异。 结论 增强BRAVO序列影像特征可用于术前评估GJT患者的Fisch分型。术前BRAVO序列的增强影像特征在不同手术入路患者间存在差异。 Abstract:Objective To investigate the relationship between the enhanced MRI features of preopera-tive brain volume imaging (BRAVO) and surgical methods in patients with glomus jugulare tumor (GJT). Methods The imaging data of enhanced BRAVO sequence and surgical methods of patients with GJT confirmed by surgery and pathology from February 2015 to March 2021 in Peking Union Medical College Hospital were analyzed retrospectively. According to the surgical mode, the patients were divided into the groups of single infra-temporal fossa approach (IFA) group and combined infratemporal fossa approach (CIFA) group. Both groups of patients underwent MRI examination before operation, and the Fisch classification of tumor was determined based on the characteristics of enhanced BRAVO sequential images, and the consistency was compared with the Fisch classification determined during the operation. The maximum diameter of the tumor in the transverse axis, the longest diameter in the coronal plane, the width diameter of meningeal invasion and the depth diameter of meningeal invasion were measured and compared between two groups. Results A total of 25 patients were included. Among them, 16 cases were in the IFA group (surgical approach was infratemporal fossa type A), and 9 cases in the CIFA group (surgical approach was infratemporal fossa type A + type B). The classification of image C includes 1 case of C1 type, 10 cases of C2 type, 12 cases of C3 type, and 2 cases of C4 type. The classification of image D includes 8 cases of De1 type, 6 cases of Di1 type, and 5 cases of Di2 type. Except for one patient in the IFA group who was evaluated as C3 preoperatively based on imaging, and confirmed as C2 postoperatively, the image classification of C and D of the other patients were consistent with those of surgical classification of C and D (Kappa=0.934, P < 0.001;Kappa=1.000, P < 0.001). Image classification of C (P=0.029) and D (P=0.006) had significant differences between the two groups. The maximum diameter(P=0.013), depth(P=0.003) and width of meningeal invasion(P=0.011) in the CIFA group were greater than those in the IFA group. There was no significant difference in the longest diameter of the coronal plane (P=0.125) between the two groups. Conclusions Enhanced BRAVO sequence can be used for preoperative evaluation of Fisch classification of GJT. The enhanced image features based on BRAVO sequence showed differences between the two different surgical approaches. 作者贡献：陈钰负责研究设计、数据分析、论文撰写与修改；冯国栋、田旭负责临床资料收集、数据分析；苏童、毛铭阳负责临床资料收集、数据分析、论文撰写；徐振潭、周海龙、房洪营负责影像资料收集；高志强负责指导研究设计；金征宇、张竹花负责指导研究设计、数据审核及论文审校。利益冲突：无 -
图 1 颈静脉球瘤患者增强脑容积成像序列特征(箭头)及Fisch C型分型
A.右侧颈静脉球瘤未累及颈内动脉，为影像分型C1型；B.左侧颈静脉球瘤侵犯颈动脉管垂直段，为影像分型C2型；C.左侧颈静脉球瘤沿颈内动脉水平段生长，未达破裂孔，为影像分型C3型；D.右侧颈静脉球瘤侵犯破裂孔，为影像分型C4型
图 2 颈静脉球瘤患者增强脑容积成像序列特征(箭头)及Fisch D型分型
A.右侧肿瘤侵犯脑膜，未侵入颅内，侵犯脑膜宽度29.1 mm，脑膜移位深度7.5 mm，为影像分型De1型；B.右侧肿瘤侵入颅内，侵犯脑膜宽度22.5 mm，侵入颅内深度11.6 mm，为影像分型Di1型；C.左侧肿瘤侵入颅内，侵犯脑膜宽度30.7 mm，侵入颅内深度12.2 mm，累及左侧舌下神经管，为影像分型Di2型
表 1 不同手术入路患者的术前增强脑容积成像序列影像特征比较(x±s, mm)
组别 横轴位肿瘤最大径 冠状位肿瘤最长径 脑膜侵犯深度* 脑膜侵犯宽度* IFA组(n=16) 23.54±9.09 25.94±13.44 5.42±2.71 15.80±5.39 CIFA组(n=9) 35.02±12.03 37.19±22.13 10.70±3.92 26.67±10.56 P值 0.013 0.125 0.003 0.011 IFA：颞下窝入路；CIFA：颞下窝联合入路；*仅适用于术前影像Fisch分型D型患者 
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