弥散张量成像对胶质瘤手术风险的评估

Evaluation on operative risk of glioma by diffusion tensor imaging

目的探讨弥散张量成像（diffusion tensor imaging，DTI）在胶质瘤手术中对于保护神经功能的临床价值。方法38例胶质瘤患者手术前后行DTI检查和神经功能评价。根据胶质瘤与其邻近部位白质纤维束的影像学关系DTI可以被分为三种类型：Ⅰ类-挤压型，Ⅱ类-浸润型，Ⅲ类-破坏型。三组患者之间术前神经功能状态的差异以及三组患者之间术后神经功能改变情况的差异分别进行比较。结果Ⅰ类-挤压型14例，Ⅱ类-浸润型16例，Ⅲ类-破坏型8例。不同DTI类型患者的术前神经功能状态之间以及不同DTI类型患者的术后神经功能改变情况之间的差异有统计学意义（P〈0．05）。结论DTI能够显示胶质瘤与临近的白质纤维束之间的关系，体现了胶质瘤不同的生长方式，它能够帮助神经外科医生选择更加安全的手术人路和决定肿瘤切除程度。

Objective To elucidate the clinical significance of diffusion tensor imaging （DTI） mainly used for protecting neurological functions in patients with gliomas. Methods Thirty - eight patients with gliomas were recruited to undergo DTI test and assess the status of neurological functions before and after surgery. According to the relationships between gliomas and adjacent white matter （WM） tracts, DTI can be classfied as the following types ： type Ⅰ - displacement ; type Ⅱ - Infiltration ; type Ⅲ - Disruption. The neurological functions before surgery were compared in three groups, as well as the change of neurological functions after surgery was also compared in three groups. Results There were 14 cases in type Ⅰ , 16 cases in type 11, and 8 cases in type m. There were significant difference between DTI types and preoperative neurological functions, as well as between DTI types and the change of postoperative neurological functions （ P 〈 0. 05 ）. Conclusions DTI allows to visualizate the relationships of gliomas and adjacent WM tracts, which represent the different growth patterns of gliomas. It is useful for neurosurgeons to select suitable surgical approaches and determine appropriate extent of resection.