超选择性动脉自旋标记评估脑膜瘤供血动脉与脑侵袭
该前瞻性研究纳入26例脑膜瘤患者，术前采用超选择性动脉自旋标记（SS-ASL）选择性标记颈外动脉、颈内动脉或椎动脉评价供血动脉，并与常规血管造影对照。结果显示SS-ASL对供血动脉的识别与血管造影一致率超过93%图像及80%病例；对脑侵袭检出的敏感度为100%，特异度为65%，阴性预测值为100%。
要点
- SS-ASL可较可靠显示脑膜瘤供血动脉，有助于术前规划。
- 肿瘤-脑实质界面出现颈内动脉/椎动脉灌注信号时需警惕脑侵袭。
- 阴性预测值高，未见该征象时脑侵袭可能性较低。
核心结论
- SS-ASL是一种无创且可靠的脑膜瘤供血动脉识别技术。
- 对脑侵袭具有较好的术前筛查价值，阴性预测值为100%，可用于排除侵袭并辅助手术规划。
研究设计与样本
- 前瞻性研究，纳入26例脑膜瘤患者。
- 术前采用SS-ASL选择性标记颈外动脉、颈内动脉或椎动脉。
- 由两名有资质放射科医师评价供血动脉识别准确性，以常规血管造影为参照。
- 通过肿瘤-脑实质界面的灌注模式评价脑侵袭预测价值。
关键影像表现/征象
- 脑侵袭病例在肿瘤-脑实质界面可见颈内动脉/椎动脉来源的标记信号。
诊断标准与关键数值
- 判别脑侵袭：SS-ASL对病理证实的6例脑侵袭全部正确识别，敏感度为100%。
- 在7例无病理侵袭证据病例中也出现颈内动脉/椎动脉信号，特异度为65%。
- 阴性预测值为100%。
临床应用与阅片要点
- 术前可用SS-ASL无创判断脑膜瘤主要供血动脉来源以辅助介入或手术预案。
- 界面灌注提示脑侵袭时，应在报告中提示手术风险评估。
- 界面未见颈内动脉/椎动脉信号时，可较为放心地作为排除脑侵袭的依据。
局限性
- 样本量较小，仅26例患者。
- 脑侵袭阳性例数仅6例。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND PURPOSE: This study aimed to assess the utility of superselective arterial spin labeling (SS-ASL) in identifying the feeding arteries of meningiomas and in predicting brain invasion.
MATERIALS AND METHODS: A prospective study was conducted with 26 patients with meningiomas. Preoperative SS-ASL was used to selectively label the external carotid artery, ICA, or vertebral artery. Two board-certified radiologists evaluated the accuracy of feeding artery identification by comparing SS-ASL findings with conventional angiography. Perfusion patterns at the tumor-parenchyma interface were further evaluated as a potential surrogate marker for predicting brain invasion.
RESULTS: SS-ASL identification of feeding arteries corresponded with angiography in over 93% of images and more than 80% of cases. Surgical and pathological evaluation confirmed brain invasion in 6 cases. SS-ASL correctly identified all 6 cases (sensitivity: 100%) but showed internal carotid artery/vertebral artery signals in 7 additional cases without pathological evidence of invasion (specificity: 65%), yielding a negative predictive value (NPV) of 100%.
CONCLUSIONS: SS-ASL is a noninvasive and reliable technique for identifying meningioma feeding arteries. It also shows strong potential for preoperative screening of brain invasion; its high NPV suggests it may be useful for ruling out invasion and aiding surgical planning.
引用
- Katsube, Gobara, Asou, et al. Usefulness of Superselective Arterial Spin Labeling for Evaluating Feeding Arteries and Brain Invasion in Meningiomas. AJNR Am J Neuroradiol. 2026. PMID: 42229995. doi:10.3174/ajnr.A9442
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。