目的:本研究旨在分析我院脑胶质瘤患者术后发生脑梗死的危险因素。并比较医学影像技术对术后脑梗死的早期诊断价值。
方法:回顾性分析2015年5月至2023年10月在我院接受胶质瘤手术的178例患者(男78例,女100例)。根据术后7天内是否发生脑梗死分为两组:脑梗死组(n=85)和非脑梗死组(n=93)。磁共振成像(MRI)用于评估位置,分布,手术前肿瘤的体积。围手术期,患者术后时间,术中失血,并记录了其他相关数据。CT灌注成像(CTP)和弥散加权成像(DWI)成像技术用于评估发生,area,location,和脑梗塞的形状。观察术后脑梗死的影像学特点。表观扩散系数值,全脑CTP参数的表观扩散系数(ADC),脑血流量(CBF),脑血容量(CBV),达到峰值的时间(TTP)平均运输时间(MTT),和测量DWI参数。CTP的敏感性和特异性,DWI,并比较了他们对术后脑梗死的联合诊断,使用Kappa值评估一致性。
结果:本研究发现85例(47.8%)患者术后发生脑梗塞。显著的危险因素包括肿瘤位于颞叶,肿瘤体积≥23.57cm3,手术数>1,世界卫生组织(WHO)分级>3,术中出血量>79.83mL(p<0.05)。影像学检查显示,CTP结合DWI诊断发现84例脑梗死,显示较低的CBF和CBV,和更高的TTP,和MTT在梗死组(p<0.05)。CTP的Kappa值,DWI,合并诊断分别为0.762、0.833和0.937(p<0.001)。
结论:脑胶质瘤患者脑梗死患病率高,且受多种因素影响。及时的影像学检查可以发现和预测患者术后脑梗死的发生,对改善患者预后具有重要意义。
OBJECTIVE: The aim of our study was to analyze risk factors for postoperative cerebral infarction in patients with glioma in our hospital, and to compare medical imaging techniques for early diagnosis of postoperative cerebral infarction.
METHODS: A retrospective analysis was conducted on 178 patients (male: 78, female: 100) who underwent glioma surgery at our hospital between May 2015 and October 2023. They were divided into two groups based on the presence of postoperative cerebral infarction within 7 days: the cerebral infarction group (n = 85) and the non-cerebral infarction group (n = 93). Magnetic resonance imaging (MRI) was used to assess the location, distribution, and volume of the tumor before surgery. During the perioperative period, patient postoperative time, intraoperative blood loss, and other relevant data were documented. Computed tomography perfusion (CTP) and diffusion-weighted imaging (DWI) imaging techniques were employed to evaluate the occurrence, area, location, and shape of cerebral infarction. The imaging characteristics of postoperative cerebral infarction were noted. Apparent diffusion coefficient values, apparent diffusion coefficient (ADC) of whole-brain CTP parameters, cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and DWI parameters were measured. The sensitivity and specificity of CTP, DWI, and their combined diagnosis for postoperative cerebral infarction were compared, with consistency assessed using the Kappa value.
RESULTS: This study found that 85 patients (47.8%) experienced postoperative cerebral infarction. Significant risk factors included tumor location in the temporal lobe, tumor volume ≥23.57 cm3, number of surgeries >1, World Health Organization (WHO) grade >3, and intraoperative blood loss >79.83 mL (p < 0.05). Imaging examinations revealed that CTP combined with DWI diagnosis detected cerebral infarctions in 84 patients, showing lower CBF and CBV, and higher TTP, and MTT in the infarct group (p < 0.05). The Kappa values for CTP, DWI, and the combined diagnosis were 0.762, 0.833, and 0.937, respectively (p < 0.001).
CONCLUSIONS: The prevalence of cerebral infarction in patients with glioma is high and is affected by many factors. Timely imaging examination can detect and predict the occurrence of cerebral infarction in patients after surgery, which is of great significance for improving the prognosis of patients.