2023 年3 期 第31 卷
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3D-Slicer软件在脑膜瘤患者发生术后瘤周水肿加重评估中的应用价值
ApplicationValueof3D-SlicerSoftwareintheEvaluationofPostoperativePeritumoralBrainEdemaAggravationinPatientswithMeningioma
作者:张恒,陶胜忠,刘展,马帅
- 单位:
- 郑州大学第二附属医院神经外科
- 单位(英文):
- DepartmentofNeurosurgery,theSecondAffiliatedHospitalofZhengzhouUniversity,Zhengzhou450014,China
- 关键词:
- 脑膜瘤; 术后瘤周水肿; 水肿指数; 三维重建; 3D-Slicer;
- 关键词(英文):
- Meningioma;Postoperativeperitumoralbrainedema;Edemaindex;Three-dimensionalreconstruction;3D-Slicer
- 中图分类号:
- R739.45
- DOI:
- 10.12114/j.issn.1008-5971.2023.00.077
- 基金项目:
- 2020年河南省医学教育研究项目( Wjlx2020086?)
摘要:
目的 探讨3D-Slicer软件在脑膜瘤患者发生术后瘤周水肿(PTBE)加重评估中的应用价值。方法回顾性选取2020年10月至2022年6月于郑州大学第二附属医院神经外科接受手术治疗的脑膜瘤患者129例,将发生术后PTBE加重的患者作为术后PTBE加重组(n=37),其余患者作为无术后PTBE加重组(n=92)。比较两组年龄、性别、术前水肿指数(EI)、肿瘤体积、Ki-67、术中引流静脉受损情况、肿瘤良恶性情况、癫痫发作情况。采用多因素Logistic回归分析探讨脑膜瘤患者发生术后PTBE加重的影响因素。采用ROC曲线评估术前EI和肿瘤体积对脑膜瘤患者发生术后PTBE加重的预测价值。结果 术后PTBE加重组术前EI低于无术后PTBE加重组,肿瘤体积大于无术后PTBE加重组,Ki-67、术中引流静脉受损者占比高于无术后PTBE加重组(P<0.05)。多因素Logistic回归分析结果显示,术前EI升高、肿瘤体积增大、Ki-67升高是脑膜瘤患者发生术后PTBE加重的危险因素,术中引流静脉未受损是脑膜瘤患者发生术后PTBE加重的保护因素(P<0.05)。ROC曲线分析结果显示,术前EI及肿瘤体积预测脑膜瘤患者发生术后PTBE加重的AUC分别为0.83[95%CI(0.77,0.90)]、0.80[95%CI(0.73,0.88)],最佳截断值分别为123%、24.5 cm3,灵敏度分别为83.8%、75.7%,特异度分别为73.9%、65.2%。结论 术前EI升高、肿瘤体积增大、Ki-67升高是脑膜瘤患者发生术后PTBE加重的危险因素,而术中引流静脉未受损是脑膜瘤患者发生术后PTBE加重的保护因素,且术前EI及肿瘤体积对脑膜瘤患者发生术后PTBE加重有较好的预测价值。未来可借助3D-Slicer软件评估脑膜瘤患者术前EI及肿瘤体积以预测术后PTBE加重发生风险,进而对患者进行个体化干预。
英文摘要:
ObjectiveToinvestigatetheapplicationvalueof3D-Slicersoftwareintheevaluationofpostoperativeperitumoralbrainedema(PTBE)aggravationinpatientswithmeningioma.MethodsAtotalof129patientswithmeningiomawhoreceivedsurgicaltreatmentintheDepartmentofNeurosurgery,theSecondAffiliatedHospitalofZhengzhouUniversityfromOctober2020toJune2022wereretrospectivelyselected.PatientswithpostoperativePTBEaggravationwereclassifiedaspostoperativePTBEaggravationgroup(n=37),andtheotherswereclassifiedasnopostoperativePTBEaggravationgroup(n=92).Age,gender,preoperativeedemaindex(EI),tumorvolume,Ki-67,intraoperativedrainageveindamage,benignandmalignanttumor,andepilepticseizurewerecomparedbetweenthetwogroups.MultivariateLogisticregressionanalysiswasusedtoinvestigatetheinfluencingfactorsofpostoperativePTBEaggravationinpatientswithmeningioma.ROCcurvewasusedtoevaluatethepredictivevalueofpreoperativeEIandtumorvolumeforpostoperativePTBEaggravationinpatientswithmeningioma.ResultsThepreoperativeEIofpostoperativePTBEaggravationgroupwaslowerthanthatofnopostoperativePTBEaggravationgroup,tumorvolumewaslagerthanthatofnopostoperativePTBEaggravationgroup,Ki-67andtheproportionofpatientswithintraoperativedrainageveindamagewerehigherthanthoseofnopostoperativePTBEaggravationgroup(P<0.05).TheresultsofmultivariateLogisticregressionanalysisshowedthatincreasedpreoperativeEI,tumorvolumeandKi-67wereriskfactorsforpostoperativePTBEaggravationinpatientswithmeningioma,andnointraoperativedrainageveindamagewasprotectivefactorforpostoperativePTBEaggravationinpatientswithmeningioma(P<0.05).ROCcurveanalysisresultsshowedthattheAUCofpreoperativeEIandtumorvolumeforpredictingpostoperativePTBEaggravationinmeningiomapatientswas0.83[95%CI(0.77,0.90)]and0.80[95%CI(0.73,0.88)],theoptimalcut-offvaluewas123%and24.5cm3,thesensitivitywas83.8%and75.7%,andthespecificitywasand73.9%and65.2%,respectively.ConclusionTheincreasedpreoperativeEI,tumorvolumeandKi-67areriskfactorsforpostoperativePTBEaggravationinpatientswithmeningioma,andnointraoperativedrainageveindamageisaprotectivefactorforpostoperativePTBEaggravationinpatientswithmeningioma,andpreoperativeEIandtumorvolumehavegoodpredictivevalueforpostoperativePTBEaggravationinpatientswithmeningioma.Inthefuture,3D-SlicersoftwarecanbeusedtoevaluatepreoperativeEIandtumorvolumeofmeningiomapatientstopredicttheriskofpostoperativePTBEaggravation,soastocarryoutindividualizedinterventionforpatients.
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