磁共振弥散张量成像在脑胶质瘤手术前后的价值

The value of magnetic resonance diffusion tensor imaging in glioma surgery

目的 探讨磁共振弥散张量成像在脑胶质瘤手术前后的价值.方法回顾性分析2010年5月-2013年10月我院收治的20例脑胶质瘤患者及20例来我院进行健康体检的健康人并进行MRI及DTI检查.分析低级别胶质瘤及高级别胶质瘤与相邻脑白质纤维束的解剖关系及临床症状的评价,比较高级别胶质瘤患者胶质瘤病灶区、灶周水肿区及正常白质区的MD值、FA值.结果低级别胶质瘤（Ⅰ-Ⅱ级共13例）推移相邻脑白质纤维束,手术效果较好,切除充分,患者的临床症状在术后较术前均明显改善.高级别胶质瘤（Ⅲ-Ⅳ级共7例）浸润、破坏相邻脑白质纤维束,患者的临床症状在术后较术前改善不明显.三个区域的MD值由高到低依次为：胶质瘤病灶区、灶周水肿区、正常白质区,差异有统计学意义（P＜0.05）,胶质瘤病灶区MD值高于灶周水肿区,但无统计学意义（P＞0.05）.FA值由高到低依次为正常白质区、灶周水肿区、胶质瘤病灶区,有统计学意义（P＜0.05）.结论 DTI技术对手术方案的制定、手术切除范围的判断均有积极的作用,并且对手术风险的评估及患者疾病预后的预测也有重要的作用.

Objective To investigate the diffusion tensor imaging＇ in glioma before and after surgery. Methods The 20 eases of glioma patients and 20 eases healthy people collected from May 2010 in October 2013 in our hospital and did MRI and DTI examination were retrospective analyzed. Analyze the low-grade gliomas and high-grade gliomas and anatomical relationships and evaluation of clinical symptoms of the adjacent white matter fiber tracts, relatively high- grade glioma patients with glioma lesions, perifocal edema and normal white matter areas MD values, FA values. Results The low-grade gliomas （ I - II grade of 13 cases） went on the adjacent white matter fiber tracts, better surgical resection full, the clinical symptoms were significantly improved after surgery than before surgery. High-grade gliomas （III- IV grade 7 cases） infiltration, destruction of adjacent white matter fiber tracts, clinical symptoms after surgery improvement were not obvious. MD value of the three regions in descending order：glioma lesions, perifocal edema, normal white matter, with statistical significance （P 〈0.05）, MD lesions greater than the value of glioma perifocal edema area, but not statistically significant （P〉 0.05）. FA values in descending order as normal white matter,perifocal edema,glioma lesions was statistically significant （P 〈0.05）. Conclusion DTI technology program developed for surgery, surgical resection of the judgment has a positive effect, and the surgical ris assessment and prediction of prognosis in patients with the disease also have an important role.