脑胶质瘤能早期发现和治疗吗？汇总

1、脑胶质瘤能早期发现和治疗吗？脑胶质瘤能早期发现和治疗吗？脑胶质瘤早期发现的方法脑胶质瘤早期发现的方法典型典型IDLGG的的MRI表现表现IDLGG发现率发现率临床面临的问题临床面临的问题它像什么？它像什么？它像什么？它像什么？它是它是LGG吗？吗？MRS质控质控3T比比1.5T好好MRS 无公认的无公认的LGG值值MRS检测检测IDH突变产物突变产物瘤样脱髓鞘病瘤样脱髓鞘病:rCBVrCBV1.51.5星形瘤少枝恶少枝pMR（GRE）6m12mLGGHGG(Olig)rCBVrCBV准确性准确性rCBV+MRSPE/CTPET/MRIPET预测进展预测进展GBM2月后2.4(L/B)2.5注意

2、点注意点观察等待还是积极处理观察等待还是积极处理观察等待观察等待早期手术早期手术早期手术早期手术IDLGGsSymptomatic LGGs p-valueNo. of cases24198Reasons for imaging in IDLGGs (%) Trauma11(45.8)- Dizziness7(29.2)- Headache6(25.0)-Clinical characteristics Mean age at diagnosis(years)42.42.539.00.70.117 Sex, Male/Female13/11118/800.610 Median preopera

3、tive KPS100900.001Radiological findings Main tumor location 0.362 Frontal16120 Temporal345 Parietal416 Occipital16 Insular011Biomarker？华山病例华山病例IDLGGsSymptomatic LGGsp-value Mean tumor volume (cm3)22.75.065.25.60.010 Contrast enhancement, Yes/No7/974/670.508 Midline shift, Yes/No1/1666/440.001 Eloque

4、nt area involvment2/22112/850.001Pathological classification0.001 Grade 2 Astrocytoma7128 Grade 2 Oligodendroglioma654 Grade 2 Oligoastrocytoma1113 Ganglioglioma02 Surgical treatment0.032 Gross total resection22141 Subtotal or partial resection 257Figure 1 Kaplan-Meier survival curves for OS in pati

5、ents with IDLGGs and Symptomatic LGGsOS(yrs)5y8y10yIDLGG87.5%83.3%75%SLGG71.6%58.7%50.7%IDH mutation 95.7%(22/23)1p/19q co-deletion 69.6%(16/23)Does W/W justify?华山方案华山方案华山方案华山方案IDLGG特征特征影响影响LGG预后因素预后因素最大安全程度切除肿瘤最大安全程度切除肿瘤DTI-based functional navigationnProspective, randomized controlled studyn238 pa

6、t c gliomas involving PTnFA & FT techs was used for DTI(Wu JS, etal. Neurosurg 2007, 61:935)（II级）级）神经导航外科神经导航外科BOLD技术技术皮层电刺激皮层电刺激疗效比较疗效比较例数例数不全不全切除切除全切除全切除轻度致瘫轻度致瘫*(肌力下降肌力下降12度度)重度致瘫重度致瘫*(肌力下降肌力下降3度度)无手术致瘫无手术致瘫组组别别对照组对照组282811(39.8%)11(39.8%) 17(60.7%)17(60.7%)8(28.6%)12(42.8%)8(28.6%)试验组试验组30309(13

7、.3%)9(13.3%) 26(86.7%)26(86.7%)6(20.0%)1(3.3%)23(76.7%)优：很健康，无不适主良：健康，有轻度症状好：有中度症状，需经中：生活自理，不能参次：生活基本自理，有差：生活不能自理残：需特别护理和照顾重残：需住院，病情重垂死：濒临死亡死亡Missing病例数20181614121086420统计分组对照组试验组KPS（3月）月）（II级）级）应用应用DTI和和fMR注意事项注意事项（Ganslandt 2005Ganslandt 2005）肿瘤边界界定3T-3D MRS：界定肿瘤边界：界定肿瘤边界胶质瘤胶质瘤MRS全切全切iMR5-ALAP平均残瘤0.5(0-4.7)cm31.9(0-13.2)cm30.022GTR(%)74460.056M-PFS（%）4532围手术期并发症无差别（Roder C 2014）3T iMR导航脑胶质瘤手术：导航脑胶质瘤手术：RCT、三盲研究、三盲研究(中期报告中期报告)病人资料对比病人资料对比IDHIDH突变突变MGMTMGMT甲基化甲基化 无差别无差别放化疗放化疗iMR(%)常规导航(%)P1st切除50460