DTI多参数值及DTT技术在颅内肿瘤中的应用研究

The Clinical Application of DTI Multiple Parameter Value and DTT in Intracranial Tumors

目的探讨MR扩散张量成像(DTI)多参数值在脑肿瘤中的诊断和鉴别诊断价值;评价扩散张量纤维束成像(DTT)在显示脑肿瘤与周围脑白质纤维束关系中的应用。资料与方法搜集经手术病理证实的星形细胞瘤(低级别、高级别)、脑膜瘤、转移瘤患者资料(低级别星形细胞瘤15例,高级别星形细胞瘤18例,脑膜瘤16例,转移瘤10例)共59例。行常规T1WI、T2WI、增强T1WI及DTI。测量病灶肿瘤实质区、瘤周水肿区、囊变坏死区、水肿邻近正常白质区及对侧正常白质区的平均扩散系数(DCavg)值、部分各向异性分数(FA)值、1-容积比(1-VR)值及相对各向异性(RA)值,分析各测量值在肿瘤的诊断及良恶性鉴别诊断中的作用。利用DTI数据进行DTT重组病变周围脑白质纤维束,观察肿瘤与脑白质纤维束的关系。结果低级别星形细胞瘤、高级别星形细胞瘤、脑膜瘤及转移瘤的肿瘤实体、瘤周水肿区的FA值、1-VR值及RA值差异均具有统计学意义(P<0.05);对侧正常白质区DCavg值、FA值、1-VR值及RA值差异均具有统计学意义(P<0.05)。FA图、FA彩色编码图、DTT图均能显示脑白质纤维受累情况,而常规MRI难以显示;脑白质纤维束与脑肿瘤的位置关系可分为四型,即推挤型、水肿型、浸润型和破坏型。低级别星形细胞瘤及脑膜瘤良性肿瘤周围的白质纤维束多呈推挤水肿改变,而高级别星形细胞瘤及转移瘤恶性肿瘤周围的白质纤维束多表现为以浸润破坏为主。结论DTI较常规MRI能更确切、直观地显示脑内肿瘤与周围脑白质的关系,结合FA值、1-VR值及RA值能为肿瘤的诊断及鉴别诊断提供更多的依据;DTT可以为临床提供更多的肿瘤及其周围白质纤维束的信息,指导术前计划的制定和术后的评估。

Objective To study the value of multiple parameter DTI in the diagnosis and differential diagnosis of brain tumors,and to evaluate clinical benefit of DTT in display the brain white matter fiber.Materials and Methods 59 patients with brain tumors（33 astrocytoms,16 meningiomas and 10 metastatic tumors） confirmed by histological results underwent conventional MRI,DTI and reconstruct DTT.DCavg,FA,1-VR and RA were measured in each ROI,which were compared with the values of ROI in the contralateral side.The brain white matter fibers were rebuild to display the correlation of brain tumors with white matter fibers.Results There was significant difference of FA,1-VR and RA values in the solid part of tumors,the peritumoral edema and the white matter area surrounding the edema.The values of Normal brain area had significant difference compare with that of tumor area.The peritumoral white matter in low-grade astrocytomas and meningiomas were displaced,while in high-grade astrocytomas and metastatic tumors were destroyed.Conclusion DTI could show the relationship of tumor and surroundig white matter fiber clearly,and provide more information of differential diagnosis.It has great value in surgical plan for patients with brain tumors.