MRI-DTI成像DTT技术及FA值对脑膜瘤术前的指导和术后的评价作用

MRI-DTI Imaging DTT Technology and FA Values the Guidance of Meningioma Preoperative and Postoperative Evaluation

[目的]研究磁共振弥散张量成像(DTI)扩散张量纤维束成像(DTT)技术及FA值对脑膜瘤术前手术路径和范围的指导和术后患者临床症状改变的评价作用。[方法]对25例(1例多发)确诊良性脑膜瘤患者行术前常规MRI、DTI检查和术后二月余行常规MRI、DTI检查,原始数据用GE-funtool软件进行后处理,获得各向异性分数(FA)图及重建弥散张量3D纤维束(DTT)图,分析术前脑膜瘤与白质纤维束关系和术后白质纤维束破坏程度和患者临床表现改变程度。结果根据3D纤维素图像对其中13例患者术前颅骨切口位置重做修订,皮质切口范围缩小处理;8例患者肿瘤切除范围进行了重新设定,并最大程度避开功能区。手术区白质纤维束术前表现为受压变形、移位、稀疏及中断,术后25例白质纤维束均有不同程度改变,其中23例1、2级患者临床基本无症状,1例3级患者肌力有不同程度下降,白质纤维束受损明显;1例4级白质纤维束受损程度严重较稀疏,伴有较大范围完全中断;白质纤维束损伤严重程度与肌力级别呈显著负相关关系。手术区所测FA值有不同程度下降,与患者临床症状相关关系不确定。结论 DTI可为脑膜瘤变术前制订安全手术计划,提高病变的切除率,术中更好保护正常脑组织,减少患者术后运动功能障碍;DTI和DTT对观察脑组织的损害程度、预测术后恢复程度和对指导临床康复治疗具有重要作用。

[Objective] To study diffusion tensor imaging（DTI） diffusion tensor imaging（DTT） technology and the FA value of preoperative meningioma path and scope of the guidance and clinical symptoms in patients with postoperative changes in the role of evaluation.[Methods] In 25 cases（1 case of multiple） diagnosed benign meningioma patients before operation,the conventional MRI,DTI examination and conventional MRI,DTI examination after more than two months.The original data using GE-funtool software for post treatment,get fractional anisotropy（FA） diagram and reconstruction of diffusion tensor 3D cellulose（DTT） diagram,analysis of preoperative meningioma associated with white matter fiber tracts and postoperative white matter fiber damage and clinical manifestations in patients with altered levels.[Results] According to 3D cellulose images in 13 patients with preoperative skull incision position redo revision,cortical incision narrowed down processing;In 8 patients,the extent of tumor resection was reset,and the greatest degree to avoid functional area.Operation area of white matter fiber tracts in the preoperative performance for the compressive deformation,displacement,sparse and interrupt.After operation,25 cases of white matter fiber tracts has the varying degree changes.Among the 23 cases,1 patient with grade 2 basic clinical symptoms,1 case of patients with grade 3 muscle strength decline in different degrees.The white matter fiber tracts were significantly impaired;1 case of grade 4 of white matter fiber tracts damage severity was sparse.Accompanied by large range completely disrupted.white matter fiber bundle injury severity and muscle levels were significantly negatively correlated.Operation area measured FA value had different level to drop,and the clinical symptoms of patients with related uncertainty.[Conclusion] DTI for meningioma variable preoperative security operation plan,enhancing lesion resection rate,for better protection of normal brain tissue,reduction of postoperative patients with motor dysfunction;DTI and DTT on the observation of brain tissue damage degree,predicting the postoperative recovery and to guide the clinical rehabilitation plays an important role.