磁共振弥散张量成像对脑皮质运动区肿瘤患者偏瘫肢体术后运动功能的评估价值

The Value of Magnetic Resonance Diffusion Tensor Imaging in Evaluation of the Hemiplegic Limb Motor Function of the Patients with Cerebral Cortex Motor Area Cancer after Surgery

目的探讨磁共振弥散张量成像(DTI)对脑皮质运动区肿瘤患者偏瘫肢体术后运动功能的评估价值。方法选取2009年6月—2013年3月我院神经外科收治的100例脑皮质运动区肿瘤患者,手术前后均行DTI检查,比较患侧病灶兴趣区(ROI)及对侧同等大小的正常脑组织ROI的部分各向异性(FA)。在弥散张量纤维束成像(DTT)图中将皮质脊髓束(CST)的受累程度分为1、2、3、4级,比较手术前后患者CST受累程度。采用美国国立卫生院脑卒中量表(NIHSS)和简式Fugl-Meyer运动功能评定量表(FMA)分别对手术前后患者的神经功能及肢体运动功能进行评估。然后分析CST受累程度与NIHSS、FMA评分的相关性。结果脑皮质运动区肿瘤侧FA值为(0.39±0.07),低于对侧正常脑组织的(0.50±0.08)(t=10.348,P<0.01)。患者手术前后CST受累程度及NIHSS、FMA评分间差异均无统计学意义(P>0.05)。患者手术前后CST受损程度均与NIHSS评分呈正相关(术前:r=0.876,P=0.001;术后:r=0.913,P=0.000),与FMA评分呈负相关(术前:r=-0.856,P=0.007;术后:r=-0.885,P=0.004)。结论 DTI能够显示脑皮质运动区肿瘤患者CST受累程度,通过术前DTI可指导手术切除程度,同时对术后偏瘫肢体的运动功能进行评估。

Objective To investigate the value of magnetic resonance diffusion tensor imaging （DTI） in evaluation of the hemiplegic limb motor function of the patients with cerebral cortex motor area cancer after surgery. Methods From June 2009 to May 2013, 100 patients with the cerebral cortex motor area cancer were treated in Department of Neurosurgery, Hainan Pro- vincial People＇s Hospital. All cases received DTI scans, fractional anisotropy （FA） of region of interest （ROI） was compared between lesions of tumor side and contralateral normal brain tissue of the same size. The severity of corticospinal tract （CST） was divided into four grade （1 ~ 4） according to diffusion tensor tractography （DTr）, the severity of CST before and after surgery was compared. Before and after surgery, the neurological and limb movement function of patients were evaluated by the National Institutes of Health Stroke Scale （NII-ISS） and Fugl - Meyer assessment scale （FMA） . The relationship between severity of CST and NIHSS, FMA score was analyzed. Results The tumor side FA value of cerebral cortex motor area was （ 0. 39 ± 0.07 ） , which was lower than FA value of contralateral normal tissue （0.50 ± 0. 08 ）, the difference was statistically significant （ t = 10. 348, P 〈0. 01 ） . The severity of CST, NIHSS, FMA score before and after surgery were compared separately, the differ- ence was not statistically significant （P 〉 0. 05 ） . The severity of CST was positively correlated with NIHSS score before and after surgery （ preoperative： r = 0. 875, P = 0. 001 ; postoperative ： r = 0. 913, P = 0. 000）, while the severity of CST was negatively correlated with FMA score （preoperative： r = - 0. 856, P = 0. 007 ; postoperative： r = - 0. 885, P = 0. 004） . Conclusion DTI is able to show the CST severity of the patients with cerebral cortex motor area cancer, preoperative DTI can provide evidence to resection degree, postoperative DTI can evaluate the hemiplegic limb motor function.