颅内肿瘤伽玛刀治疗后疗效的影像学评估

目的 回顾性分析颅内肿瘤伽玛刀治疗后的影像学表现,为疗效判断提供依据.方法 颅内肿瘤227例(良性肿瘤127例,恶性肿瘤100例)中,81例获病理诊断,146例经临床及影像诊断.周边剂量8～25Gy(平均16.7 Gy),中心最大剂量16～50 Gy(平均25.4Gy).伽玛刀治疗后定期行CT或MRI复查,影像随访时间为恶性肿瘤3～36个月(平均12个月),良性肿瘤6～42个月(平均28个月).结果 65例脑转移瘤、生殖细胞瘤和淋巴瘤中,肿瘤缩小或消失60例(92.3%),增大5例(7.7%);35例胶质瘤中肿瘤缩小或消失14例 (40%),大小不变11例 (31.4%),增大10例 (28.6%);127例良性肿瘤中肿瘤消失或缩小69例(54.3%),大小不变58例 (45.7%).总有效率为93.4%.伽玛刀治疗后新出现瘤周水肿或原有瘤周水肿加重30例(13.2%),瘤内出血8例(3.5%).结论 伽玛刀治疗颅内肿瘤局部控制率高,并发症少,影像学随访是疗效判断的关键.

Imaging Evaluation of Intracranial Neoplasms After Gamma Knife Radiosurgery

Objective To observe the imaging manifestations of intracranial neoplasms after gamma knife radiosurgery (GK),in order to provide diagnostic basis for therapeutic effect.Methods Of 227 cases,127 were benign tumors,100 malignancies.The doses for the tumor margin and center were 8~25Gy (mean 16.7Gy),16~50Gy (mean 25.4Gy), respectively. All patients were examined with CT or MRI and the imaging manifestations were analyzed after GK,retrospectively.Results During the follow-up period of 3~36 months,of 65 cases of brain metastases,germinomas and lymphomas,tumor size decreased or vanished in 60 cases (92.3%),increased in 5 cases (7.7%). Of 35 glimases,tumor size decreased or vanished in 14 cases (40%),stabled in 10 cases (31.4%),increased in 10 cases (28.6%).During the follow-up period of 6~42 months,of 127 cases of benign tumors,tumor size stabled in 58 cases(45.7%),decreased or vanished in 69 cases (54.3%).The total efficient rate was 93.4%.Conclusion GK is an effective therapeutic method for treatment of intracranial neoplasms.Imaging examination is the key to judgement for therapeutic effect of GK.