【摘要】 目的探讨弥散张量成像(DTI)技术辅助高级别脑胶质瘤手术的临床效果。方法将该院2006年5月—2015年10月收治的93例高级别脑胶质瘤患者按诊治方法不同分为DTI组(41例)和对照组(52例)。DTI组患者术前行DTI检查,根据DTI技术显示的影像结果手术切口选择避开传导束的脑沟进入。对照组患者术前常规行MRI检查,手术切口选择距离肿瘤较近的脑沟进入。观察行DTI检查患者不同病灶部位的平均弥散系数(MD)、部分各向异性指数(FA)。比较二组患者肿瘤切除率及术后新发功能损害情况。结果 DTI检查结果发现,与正常白质区比较,肿瘤病灶区、瘤周水肿区MD值明显增高,FA值均明显降低(P<0.05);肿瘤病灶区与瘤周水肿区FA值比较差异有统计学意义(P<0.05),而MD值比较差异无统计学意义(P>0.05)。二组均无手术死亡患者。DTI组患者全切除率为90.2%(37/41)。对照组为84.6%(44/52),二组比较差异无统计学意义(P>0.05)。DTI组患者术后未见新发功能损害表现,对照组患者新发功能损害发生率为23.1%(12/52),二组比较差异有统计学意义(P<0.05)。结论 DTI技术能明确界定高级别胶质瘤病灶区、瘤周水肿区及正常白质区,并能明确显示脑胶质瘤与脑白质纤维束的关系,可辅助选择适宜的手术入路及最大限度地切除肿瘤的同时避免新的神经功能损害,值得临床推广。更多还原

【Abstract】 Objective To explore the clinical effects of magnetic resonance diffusion tensor imaging technology in the high-grade gliomas surgery.Methods The clinical data of 93 patients with high-grade glioma from May 2006 to October 2015 in author’s hospital were been chosen,and they were divided into two groups,DTI group(41 cases)and control group(52 cases).The DTI group:the skin incision was chosen to avoid tracts sulci according to the relationship between preoperative tumor DTI display and function tracts;while the control group:the patients were underwent routine MRI examination and enhanced scan before surgery,they were chosen from the trench into the brain tumor closer.The average diffusion coefficient(MD)and fractional anisotropy index(FA)in different parts of glioma DTI of patients in DTI group were observed.The rates of tumor resection,postoperative nerve function damage of patients in two groups were observed.Results With DTI findings,compared with the normal white matter,MD value of patients in the DTI group with tumor lesions,perifocal edema were higher(P<0.05).But the differences were not statistically significant compared with the MD value of tumor lesions and peritumoral edema(P>0.05).Compared with the normal white matter,FA value of patients in the DTI group with tumor lesions,perifocal edema were lower(all P<0.05).The differences were statistically significant compared with the FA value of tumor lesions and peritumoral edema(P<0.05).There were no operative deaths.The rate of total resection in the DTI group was 90.2%(37/41),and the control group was 84.6%(44/52),the difference was not statistically significant(P>0.05).There was no patients with new neurological deficit performance in the DTI group after surgery,but the incidence of new neurological deficit performance in the control group was23.1%(12/52).The difference was statistically significant(P<0.05).Conclusion DTI technology can clearly show the anatomical relationship with the surrounding glioma brain white matter fiber bundles,also can distinguish high-grade glioma tumor lesions,perifocal edema and normal white matter,provide a reasonable surgical approach for the surgeon,maximize the removal of the tumor while protecting the brain structures important functional areas and tracts.It is worthy of clinical application.更多还原