ObjectiveTo explore the value of 3.0 T MRI functional imaging in differential diagnosis of radiation brain injury and recurrence of glioblastoma multiforme.MethodsFrom March 2017 to January 2018, 31 patients diagnosed with brain glioblastoma multiforme in Peking University International Hospital were collected continuously, including 14 cases of tumor recurrence and 17 cases of radiation-induced brain injury. All the patients routinely underwent conventional MRI head scan, three-dimension arterial spin labeling (3D-ASL), dynamic susceptibility contrastperfusion weighted imaging (DSC-PWI), and enhanced MRI scan sequence; related parameters were recorded and compared.ResultsCerebral blood flow (CBF) value of abnormal enhanced area in the recurrence group was significantly higher than that in the brain injury group with 3D-ASL scan (t=3.016, P=0.005), and no difference was found in edema area between the two groups (P>0.05). In the recurrence group, CBF value of abnormal enhanced area was significantly higher than that of the normal area (t=2.628, P=0.014); however, there was no significant difference in the CBF value between the abnormal enhancement foci and the normal areas in the radiation brain injury group (P>0.05). Relative cerebral blood volume (rCBV) ratio (t=2.894, P=0.007) and relative cerebral blood volume (rCBF) ratio (t=2.694, P=0.012) of abnormal enhanced area, as well as rCBV ratio (t=2.622, P=0.013) and rCBF ratio (t=2.775, P=0.010) of edema area in the recurrence group were significantly higher than those in the brain injury group with DSC-PWI scan. No differences were found in relative mean transit time (rMTT) ratio and relative time to peak (rTTP) ratio between the two groups (P>0.05). In the brain injury groupr, CBV ratio (t=2.921, P=0.008) and rCBF ratio (t=3.100, P=0.004) of abnormal enhanced area were significantly higher than those of the edema area, and no difference was found in rMTT ratio or rTTP ratio (P>0.05). In the recurrence group, no difference was found in all focal parameters between abnormal enhanced area and edema area (P>0.05). In diagnosis value analysis, the areas under the curve of CBF in 3D-ASL scan, and rCBF ratio, rCBV ratio in DSC-PWI scan were 0.752, 0.675, and 0.645, respectively; the cut-off values were 34.59, 1.48, and 1.67, respectively; the sensitivities were 79.2%, 61.5%, and 58.3%, respectively; and the specificities were 44.4%, 32.8%, and 22.4%, respectively.ConculsionThe diagnostic value of functional MRI imaging in distinguishing glioblastoma multiforme recurrence and radiation-induced brain injury is high recommendated; further research and clinical application should be needed.
ObjectiveTo explore the clinical features, diagnosis, treatment, and prognosis of spinal pilocytic astrocytoma.MethodsFrom January 2011 to December 2017, a total of 12 cases of spinal pilocytic astrocytoma were enrolled in Department of Neurosurgery of Beijing Tiantan Hospital Affiliated to the Capital Medical University and Peking University International Hospital. They all received microscopic surgery and the pathologic diagnosis were spinal cord pilocytic astrocytoma; the clinical and radiographic features, treatment and prognosis were retrospectively analyzed.ResultsThere were 9 males and 3 females in this group, with an average age of 25.5 years. Clinical manifestations were related to tumor occupying effect. All the tumors were intramedullary tumors, in which 5 cases located in the cervical spinal cord, and 7 in the thoracic segments. Preoperative medical history recording, physical examination and imaging examination misdiagnosed the tumor as spinal cord ependymoma in 10 cases, enterogenous cyst in 1 case, and high-grade glioma in 1 case. All patients were treated with microsurgical excision: 8 were resected totally, 3 were subtotally, and 1 was partially. None of the patients died after surgery, and the mean follow-up time was 43.1 months. The symptoms of 9 patients were significantly improved, 2 showed no significant change, and 1 had worse symptoms after surgery. No reoperation occured. Two patients underwent routine radiotherapy, and no chemotherapy was performed.ConclusionsSpinal pilocytic astrocytoma tends to occur in adolescent patients with cervical and thoracic spinal cord as the predilection site; the diagnosis is mainly on the basis of tumor tissue typical two-way structure, Rosenthal fiber, and eosinophilic granular corpuscle. Preoperative medical history, physical examination and imaging examination are easily misdiagnosed as spinal cord ependymoma. Prognosis of surgical treatment is very good.