| BackgroundThe pathological grading of glioma has important influence on the prognosis and quality of life of patients.Among them,the quality of life and prognosis of lower grade patients are better than those of high grade.The prognosis of thalamic glioma patients is not only related to tumor grade,but also significantly affected by factors such as complex tumor location,difficulty in surgery,low total resection rate,and irreversible neurological impairment after resection.Therefore,if the glioma pathological grade is correctly judged before surgery,the surgical plan and adjuvant treatment for glioma patients are significantly optimized,thereby improving the prognosis of patients.Magnetic resonance imaging technology has always played a pivotal role in the field of neurosurgery,especially in the preoperative diagnosis of brain gliomas is particularly important.The recent rapid development of magnetic resonance imaging,especially the introduction of magnetic resonance diffusion imaging technology,makes it possible to accurately assess thetumor grade before surgery.Thalamic gliomas are located deep in the brain,adjacent to important nuclei and fiber bundles.They have a high surgical level and a high risk of disability.There are many factors affecting their prognosis after surgery,such as tumor grade,postoperative complications,and tumor resection.Degree and so on.Especially in terms of extent of resection(EOR),surgical resection is one of the most important steps in the treatment of glioma.The degree of excision of glioma is one of the factors that determine the prognosis and survival rate of the patient.The most extensive and safe and accurate removal of tumors is currently the most important [1-5].Intraoperative magnetic resonance can assess the degree of tumor resection during surgery,and give multiple resection of residual tumors,which may help to increase the extent of resection of brain tumors.Objective:To investigate the application of diffusion weighted imaging(DWI)in the preoperative diagnosis of thalamic gliomas;the value of intraoperative magnetic resonance navigation system in the treatment of thalamic gliomas,and the clinical diagnosis and treatment of thalamic glioma provide help.Methods:1.The first part retrospectively analyzed the preoperative routine MRI and magnetic resonance DWI imaging data of 48 patients with pathologically confirmed gliomas,including 21 low-grade gliomas(2 WHOI and 19 WHOII).There were 27 cases of high-grade gliomas(17 in WHO III and 10 in WHO IV).The apparent diffusion coefficient(ADC)value of the tumor tissue was measured on the ADC map.The statistical method was applied to a group t-test and the receiver operating characteristic curve(ROC)was used to calculate the area under the curve and to evaluate the ADC values for identifying low-grade gliomas and high-grade gliomas in thalamic gliomas.2.The second part retrospectively studied 48 patients with thalamic gliomas in neurosurgery in our hospital.All patients had signed relevant informed consent before surgery,and they were scheduled to undergo 3.0 T intraoperatively in our MRI compound operating room.Magnetic Resonance Combined with Neuronavigation for Hypothalamic Glioma Resection The preoperative routine examination required a3.0T magnetic resonance scan.Brain structure,functional cortex and conduction beams were constructed using Bold-f MRI and DTI.After the fusion of the functional images of the brain's functional cortex and nerve fibers,the afferent nerve navigation system was used to perform neuron-guided microsurgical excision of gliomas.During operation,3.0T intraoperative magnetic resonance imaging and neurological navigation were performed to update intraoperative glioma and functional structural images in real time.The preoperative and intraoperative volume of thalamic tumors were acquired in the compound operating room through a navigation workstation and the extent of tumor resection was calculated.Preoperative and postoperative evaluation of the neurological function accurately assessed the Karnofsky score and was recorded as K1(preoperatively)and K2(postoperatively).Results:1.The first part:1.1 ADC values and range of low grade gliomas(WHO grade WHOI and WHOII grades)and high grade gliomas(WHO grade III and WHO IV grade): ADC value of low grade gliomas(1.35±0.069)×10-3mm2/s,significantly higher than the ADC value of high grade glioma(1.091±0.056)×10-3mm2/s.The result was t = 2.922,P = 0.005.Two independent samples t test,P < 0.05,the difference in ADC values of low-grade thalamic glioma and high-grade glioma was statistically significant.1.2 The ADC value of WHO grade III gliomas was(1.067±0.076)×10-3mm2/s,which was significantly higher than that of WHOIV grade gliomas(1.118±0.084)×10-3mm2/s.The result was t=0.443,P=0.661.Two independent samples t test,P > 0.05,the ADC values of WHO III and WHO IV gliomas in thalamic gliomas were not statistically significant.1.3 Plot ROC Curves Based on Patient's ADC Value When the ADC is taken as 1.079×10-3mm2/s,the area under the ROC curve has the highest sensitivity at 81% and specificity at 60%,ie,the ADC value is less than1.079×10-3mm2/s.Tumor.1.4 Magnetic Resonance DWI and ADC Images of Different Pathological Grade Thalamic Gliomas Twenty-five patients with WHOI and WHOII grade glioma tumors showed low signal on DWI,6 cases showed iso-signal,and ADC images showed high signal intensity;17 cases showed high signal on DWI images of WHO III and WHO IV grade glioma tumors.There were 10 cases of equal signals,and the ADC images were obviously low signals.2.The second part:The number of MRI scans in each patient was from 1 to 3(median 1).The specific time for each intraoperative scan is about 30 minutes.Intraoperative images showed that 3 out of 48 patients had completely resected tumors,45 had residual tumors,40 of whom had further resection(Figure 2),and 5 patients with incomplete tumor resection due to intraoperative bleeding or intraoperative DTI The boundaries of the navigational residual tumor are too close to the pyramidal tract or the functional area to abandon further resection.According to the criteria of neuro-oncology assessment,7 of the 27 high-grade gliomas(HGGs)completely resected and enhanced tumors,and 7 of the 21 low-grade gliomas(LGG)completely resected tumors..The median residual tumor volume displayed by the first i MRI and final i MRI was 8.0 cm3 and 5.0 cm3,respectively.Therefore,the mean EOR for all tumors increased from 87.30±1.26% to 92.77±1.03%(P=0.0012)(Table 2,Figure 3).In the low-grade glioma group(LGG),EOR increased from 89.11±1.81% to94.95±1.19%(P=0.0108),while in the high-grade glioma group(HGG),the median EOR was from 85.88±1.72.% increased to 91.02±1.50%(P=0.0287).Nerve navigation using i MRI guidance also increased the percentage of total and near total cuts from 37.5%(18 out of 48 lesions)to 64.6%(31 out of 48 lesions).In the LGG group,the increase ranged from 33.3%(7/21)to 71.4%(15/21),and the HGG group increased from 40.7%(11/27)to 59.3%(16/27).Neurological assessment before and after surgery: Using the paired t-test,preoperative Karnofsky score(83.79±3.20)and postoperative Karnofsky score(74.31±3.48)were compared,P>0.05,and the difference was not statistically significant.Conclusions:1.Diffusion-weighted imaging has certain value in the evaluation of thalamic glioma grade diagnosis,and provides reference for preoperative planning and evaluation of patient prognosis;2.3.0T intraoperative MRI combined with neuronavigation technology can significantly improve the surgical resection rate of thalamic glioma,thereby improving the prognosis of patients.3.3.0T Intraoperative MRI combined with neuronavigation can optimize neurosurgeons' surgical strategies.It can reduce the neurological impairment of the operative area while maximally resection of thalamotomic gliomas. |
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