| Background and purpose Glioma originates from glial cells and is highly invasive.It is the most common primary central nervous system(CNS)tumor,accounting for about 30% of CNS tumors and about 80% of CNS malignant brain tumors.Most gliomas show invasive growth with fast growth rate,unclear boundary with surrounding tissues,strong invasion ability,and high morbidity,mortality and postoperative recurrence rate.At present,the main clinical treatment is surgical resection,and the principle of surgical resection is to remove the tumor to the maximum extent under the condition of reducing the neurological damage.Because the tumor often shows invasive growth,coupled with the complexity of the intracranial anatomical structure and the central nervous system,the surgical radical resection is very difficult.In addition,some cases of surgery cannot be removed completely,even complete resection of tumor still has the possibility of recurrence,and to prevent the recurrence of gliomas,the radiation and chemotherapy treatment measures patients take after surgery may cause radiation necrosis and progress in pseudo and so on in terms of imaging changes,thus determine whether the tumor recurs after surgery is still an urgent clinical problem to be solved.The resolution of soft tissue in conventional CT examination is relatively low.Although it can be used for the diagnosis and localization of intracranial tumors,it is still difficult to observe the early changes of tumor recurrence.Magnetic resonance imaging(MRI)has become the most important and commonly used method for diagnosis,differential diagnosis and therapeutic effect monitoring of intracranial tumors due to its high tissue resolution and multi-sequence,multi-parameter and multi-directional imaging.Based on this,this study took intraoperative CT(i CT)after glioma resection as the basis of observation,observed and analyzed the postoperative follow-up images,and intended to explore the imaging evolution of postoperative improvement and recurrence of gliomas,so as to provide imaging basis for early clinical detection of glioma recurrence and rational treatment.Part I: imaging follow-up of the improvement after glioma resectionObjective:To observe the series of imaging findings of the patients with glioma after surgical resection,and to discuss the evolution of the images,so as to provide the imaging basis for the correct understanding of the evolution of the images and the rational treatment of the patients with glioma after surgical resection.Materials and methods:Patients who took glioma surgery in our hospital from September 2013 to September2019 were collected,from which selected the cases who took immediate postoperative i CT check in the operating room,and after confirmed by histopathological examination after surgical removal of the glioma,with complete clinical and radiographic follow-up of 513 cases of clinical data,eliminated the cases who took preoperative chemotherapy treatments,who had other intracranial lesions,with cases of intracranial complications and whose imagings were of poor quality,a total of 250 cases,including two surgical histopathological confirmed for 72 cases of recurrent glioma.The remaining 178 cases were judged as complete resection according to the comparison of preoperative imaging and i CT manifestations,postoperative records and histopathological diagnosis after the first operation,and were judged as improved after the second operation by histopathological confirmation or combination of clinical and serial imaging data.The clinical data of 178 patients were selected as the research object to observe their serial imaging manifestations after operation.There were 100 males and 78 females,aged from 11 to 74 years,with an average age of(48±14)years.All patients underwent i CT examination in the operating room immediately after the completion of the operation,and the MRI images were reviewed about 2 weeks,3 months,6 months,9 months and 12 months after the operation.In addition to all the 178 patients underwent i CT examination,all of them underwent secondary CT reexamination within one week after surgery.Subsequently,routine head MRI was the main review,among which 169 cases were reviewed about 2 weeks after surgery,171 cases were reviewed about 3 months,162 cases were reviewed about 6 months,153 cases were reviewed about 9months and 147 cases were reviewed about 12 months.SPSS20.0 software package was used for statistical analysis and normal distribution test of measurement data.Measurement data are expressed as mean ± standard deviation(`x±s),counter related data are expressed as rate.Results:From the end of the surgery to 12 months after surgery,the imaging follow-up of the178 patients with complete glioma resection showed as follows: the residual cavity showed from large to small,and abnormal enhancement shadow gradually appeared in the residual cavity and then gradually decreased to disappear.The residual cavity wall was smooth until irregularly ringed enhancement appeared,then gradually increased,and then gradually decreased to disappear.The edema around the residual cavity gradually increased and then decreased.Conclusion:Conventional MRI examination can be used to monitor the treatment response after complete resection of glioma.For patients without recurrence after complete resection of glioma,MRI plain scan and enhanced images at different periods showed that the residual cavity wall is smooth,the residual cavity gradually shrinks and the edema around the residual cavity gradually decreases with time.Dynamic MRI imaging can provide a reliable basis for the evaluation of curative effect and subsequent treatment of patients.Part II: dynamic evolution of tumor recurrence after glioma resectionObjective:To observe the series of MRI images of glioma patients with recurrence after resection,and to discuss the evolution of the images,so as to provide the imaging basis for early detection of glioma recurrence and the formulation of appropriate treatment plan.Materials and methods:From January 2013 to September 2019,72 patients(40 males and 32 females)with recurrent glioma confirmed by histopathology after two surgical excision in our hospital were collected,aged from 21 to 69 years old.The shortest time from the first operation to the second operation was 1 month,and the longest time was 56 months,with an average of 20.4 months.All patients underwent intraoperative CT examination,and the MRI images were reviewed about 2 weeks,3 months,6 months,12 months after surgery,and 2 times before surgery,with an average of 14 times of review.Results:From the end of the first surgery to 12 months after surgery,the imaging follow-up of the 52 patients with complete tumor resection showed as follows: the tumors showed from resected clean to recurrent.The residual cavity presented from large to small,the residual cavity wall from smooth to appear as a wall nodule,and the surrounding edema from mild to severe.The average interval between the two surgeries was 25.4 months.For the 20 patients with residual tumor,from the end of the first surgery to 12 months after surgery,early reexamination showed that the residual wall nodules were visible and gradually increased,the residual cavity shrank rapidly,and edema around the residual cavity increased significantly.From the first operation to the second operation,the average interval between the two operations was 7.4 months.Conclusion:For the patients with tumor recurrence and residual after glioma resection,MRI plain scan and enhanced images at different periods showed as follows: mural nodules appeared in the surgical residual cavity wall in the early stage,and the surgical residual cavity closed in the early stage.The edema around the residual cavity gradually increased with time.During the imaging follow-up after tumor resection,the appearance of wall nodules and early closure of the residual cavity can be regarded as the reliable signs of tumor residual and recurrence.According to the comparative observation of dynamic MR imaging,postoperative tumor residual and recurrence can be detected early. |
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