ПЕРФУЗИОННАЯ КОМПЬЮТЕРНАЯ ТОМОГРАФИЯ В ДИАГНОСТИКЕ И ОЦЕНКЕ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ЗЛОКАЧЕСТВЕННЫХ ОПУХОЛЕЙ ГОЛОВНОГО МОЗГА

Abstract

Objective: To study the hemodynamic malignant brain tumors before and after radiation or conducted postoperative chemoradiotherapy. Materials and Methods. Analyzed data from multislice computed tomography (CT) and CT perfusion imaging in 27 patients: a primary malignant glial brain tumors - 20 (74,1%) patients and the presence of secondary (metastatic) brain lesions - 7 (25,9%). The study was performed on a computer tomograph Toshiba Aquilion ONE-320, with an intravenous bolus injection of the contrast agent. The authors provide data on changes in indicators of perfusion imaging in the area of brain tumor on the background of the chemoradiotherapy. MSCT perfusion assessed opportunities in monitoring patients after treatment for early detection of recurrence or further growth tumor. Results. According to the results of a comprehensive analysis of the data MDCT with intravenous contrast after total removal of the tumor noted the presence of contrast agent accumulation zone at the periphery of the field of postoperative changes. After performing PCT in the area not noted significant increases in standard measures of perfusion, indicating the presence of glial scar formation zone, and not residual tumor. When PBC was a significant increase in tumor perfusion parameters nodes, both primary and secondary nature. In terms of up to 6 months after treatment, 18,5% noted a decrease in tumor size in the standard MSCT and a gradual decrease in the degree of hyperperfusion mainly in the central parts of the tumor by 50-90% relative to the original data. In all cases, the degree of reduction of hyperperfusion was preceded by a decrease in tumor size. Lack of dynamics of perfusion and tumor size was observed in 33,4% of patients tested, which was interpreted as the stabilization process. In 48,1% of patients experienced disease progression during the period from the end of treatment to 6 months, of whom 61,5% were identified indicators increase perfusion 45-70% relative to the original data, which was preceded by an increase in tumor size. The remaining 38,5% of the patients an increase in tumor size and increase perfusion parameters were detected simultaneously. In the study, 2 patients with secondary tumors identified areas without increasing perfusion imaging chamber with a standard CT examination in the future in these areas noted the emergence of a new hearth. Conclusions. Perfusion CT is a relatively simple, minimally invasive diagnostic method that allows us to judge the dynamic changes of brain tumors during treatment, to evaluate the effectiveness of treatment in the early stages and identify the disease progression.