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Neurological Surgery No Shinkei Geka Volume 25, Issue 7 （July 1997）

Neurological Surgery 脳神経外科 25巻7号（1997年7月発行）

Japanese English

研究

頭蓋内腫瘍摘出術の術前検査としてのMRI高速FLAIR法の意義 Efficacy of the TURBO-fluid attenuated inversion recovery spin echo sequence of MRI as a preoperative neuroradiological examination 中口博 ^1,3 , 佐々木富男 ¹ , 桐野高明 ¹ , 大久保敏之 ² , 林直人 ² Hiroshi NAKAGUCHI ^1,3 , Tomio SASAKI ¹ , Takaaki KIRINO ¹ , Toshiyuki OKUBO ² , Naoto HAYASHI ² ¹東京大学脳神経外科 ²東京大学放射線科 ³諏訪中央病院脳神経外科 ¹Department of Neurosurgery Faculty of Medicine, University of Tokyo ²Department of Radiology, Faculty of Medicine, University of Tokyo キーワード： magnetic resonance imaging , fluid attenuated inversion recovery seqence（FLAIR） , intracranial tumors , surgery Keyword: magnetic resonance imaging , fluid attenuated inversion recovery seqence（FLAIR） , intracranial tumors , surgery pp.599-606

発行日 1997年7月10日 Published Date 1997/7/10

DOI https://doi.org/10.11477/mf.1436901414

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Abstract 文献概要
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I．はじめに

　FLAIR法（fluid attenuated inversion recovery sequ—ence）は，自由水の信号を抑制したT2強調画像が得られるMRIの撮像法の一種である^1-17）．脳梗塞とWir—chow Robin腔との鑑別^2,4,12-14）や，脊髄病変の描出^6,15,17）などでの有用性が指摘されているが，脳腫瘍像に関してはいまだ報告は少ない^4,12）．

　われわれは，高速FLAIR法を種々の頭蓋内腫瘍34症例に適応し，詳細に読影した上で従来の撮像法の画像と比較した．その結果FLAIR法は腫瘍摘出術を施行する上で極めて有用な撮像法であると思われたので以下に詳述する．

Whenever the extirpation of intracranial tumors is planned, neurosurgeons always keep their eyes on the cerebrospinal fluid (CSF) space around intracranial tumors. If enough space exists in the neighborhood of the tumors, the damage to adjacent parenchyma may be reduced by the procedure through the CSF space. A newly advanced MRI pulse sequence: the FLAIR (fluid attenuated inversion recovery) imaging, in which a long TE spin echo sequence is used with suppression of the CSF with an inversion pulse, displays the CSF space as a no-signal intensity area. There have been only a few reports, however, on the FLAIR pulse sequ-ence of brain tumors as yet. We examined 34 cases of intracranial tumors by FLAIR images and analyzed the advantages and disadvantages of the FLAIR pulsesequence for decision making on tumor removal.

Making use of the FLAIR pulse sequence, the CSF space is depicted as a no-signal intensity area and much more information about perifocal edema and the inva-sion area around the tumors can be provided than that provided by the other ordinary pulse sequences (T1 weighted images, T2 weighted images and Proton weighted images). Therefore, operative strategies can be more easily worked out on the FLAIR images. Furthermore, the difference between arachnoid and epidermoid is able to be detected on the FLAIR images.

Nevertheless, on FLAIR images, the tumors withoutperifocal edema or invasion to adjacent parenchyma were not apparent and the difference between tumoral dissemination into multi-ventricular space and the periventriculuar artifact of FLAIR images could not be distinguished. The FLAIR pulse sequence has other artifacts like intraventricular flow related enhancement and so on.

If the images are carefully checked up on the above-mentioned points, the FLAIR pulse sequence of MRI can not fail to be useful in making plans for operations on intracranial neoplasms.