MR-DTI对脑胶质瘤个体化手术风险及疗效评估

目的:探讨磁共振弥散张量成像(magnetic resonance diffusion tensor imaging,MR-DTI)在脑胶质瘤手术中对术者制定合适的手术方案以保护患者神经功能的临床价值。方法:33例脑胶质瘤患者术前术后行MR-DTI检查和神经功能评估。根据MR-DTI检查结果将肿瘤与瘤周白质纤维束的影像学关系分为3类:Ⅰ类-挤压型,Ⅱ类-浸润型,Ⅲ类-破坏型。对3种MR-DTI类型术前神经功能状态之间的差异、术后神经功能状态改变之间的差异以及术前术后神经功能状态之间的差异分别进行比较。结果:Ⅰ类-挤压型12例,Ⅱ类-浸润型12例,Ⅲ类-破坏型9例。①各类型内肿瘤实质FA值与对侧正常脑组织FA值比较差异有统计学意义(P<0.05);②不同MR-DTI类型患者的术前神经功能状态之间及术后神经功能改变情况之间的差异有统计学意义(P<0.05);③患者术前术后神经功能状态之间的差异有统计学意义(P<0.05)。结论:MR-DTI能够显示脑胶质瘤与肿瘤附近白质纤维束之间的关系,其能够帮助神经外科医师制定合适的手术方案以更好的保护患者的神经功能。

Clinical Evaluation and Risk of Individual Glioma Surgery by MR-DTI

Objective： To discuss the clinical value of instituting operative schedule for protecting neurological functions in patients with gliomas by magnetic resonance diffusion tensor imaging（DTI）.Methods： Thirty-three patients with gliomas were recruited to undergo MR-DTI test and neurosurgical assessment before and after surgery.According to the results of MR-DTI test,the relationships of gliomas and adjacent white matter tracts can be classified as the following three types： typeⅠ-displacement;type Ⅱ-infiltration;type Ⅲ-disruption.The differences of preoperative neurological functions,as well as the change of postoperative neurological functions and the change of both preoperative and postoperative neurological functions,were compared in the three groups.Results： There were 12 cases in typeⅠ,12 cases in type Ⅱ,and 9 cases in type Ⅲ.1.There were significant differences between gliomas＇ FA values and relative normal brain tissue＇s in each type（P0.05）.2.There were significant difference between MR-DTI types and preoperative neurological functions,as well as between MR-DTI types and the change of postoperative neurological functions（P0.05）.3.There were significant differences in the states of neurological functions before and after surgery.Conclusions： MR-DTI can be used to display the relationships of gliomas and adjacent white matter tracts,which is useful for neurosurgeons to institute suitable operative schedule for protecting patients＇ neurological function.