磁共振弥散张量成像技术在高级别胶质瘤导航术中的应用价值

Value of magnetic resonance diffusion tensor imaging technology in highgrade gliomas navigation intraoperative

目的探讨磁共振弥散张量成像技术在高级别胶质瘤导航术中的应用价值。方法2009年10月～2013年10月在汕头大学医学院第一附属医院住院治疗的27例高级别胶质瘤患者，术前均行常规的MR和磁共振弥散张量成像（DTI）技术检查，并对患者行显微外科手术治疗，皮层切口根据术前DTI显示的肿瘤与功能传导束的关系，选择避开传导束的脑沟进行。观察患者不同病变部位DTI的平均弥散系数（MD）值、部分各向异性指数（FA）值及肿瘤全切除率及患者的生存时间。结果27例高级别胶质瘤患者肿瘤病灶区、灶周水肿区及正常白质区的MD值分别为（1．260±0．268）×10^-9、（1．129±0．143）×10^-9、（0．830±0．091）×10^-9mm^2／s，与正常白质区的MD值比较，肿瘤病灶区、灶周水肿区均升高，差异均有统计学意义（P〈0．05）；27例高级别胶质瘤患者肿瘤病灶区、灶周水肿区及正常白质区的FA值分别为（0．177±0．026）、（0．221±0．034）、（0．401±0．047），3个不同部位两两比较，差异均有统计学意义（P〈0．05）。27例患者全切25例，近全切除2例，全切除率为92．6％（25，27）。术后患者临床症状改善不明显。27例患者中位生存时间为10．0个月。结论DTI能很好地显示白质纤维的走行，可区分高级别胶质瘤患者肿瘤病灶区、灶周水肿区及正常白质区，为术者提供合理的手术入路，为术中精确的影像导航提供充分的保证，使术者在不损伤脑功能结构的前提下尽可能的切除肿瘤组织，延长患者的生存期。

Objective To discuss the magnetic resonance diffusion tensor imaging technology value of the high-grade gliomas navigation intraoperative. Methods From October 2009 to October 2013, in the First Affiliated Hospital to Medical College of Shantou University, 27 patients with high-grade gliomas were given conventional MR and magnetic resonance diffusion tensor imaging （DTI） technical inspection before the surgery, patients were given microsurgery and surgical treatment, according to the relationship between preoperative tumor DTI display and function tracts skin inci- sion was chosen to avoid tracts sulci. Patients were observed the average diffusion coefficient （MD） values of different lesions DTI, fractional anisotropy index （FA） values and tumor resection rate and survival time of patients. Results MD value of 27 patients with high-grade glioma tumor lesions, perifocal edema and normal white matter areas were （1.260± 0.268）10^-9, （1.129±0.143）10^-9, （0.830±0.091）10^-9 mm^2/s, compared with normal white matter areas, MD value of tu- mor lesions, perifoeal edema, the differences were statistically significant （P 〈 0.05）; FA values of 27 patients with high-grade glioma tumor lesions, perifocal edema and normal white matter area were （0.177±0.026）, （0.221±0.034）, （0.401 ±0.047）, two different parts of the pairwise were compared, the differences were statistically significant differ- enees （P 〈 0.05）. Among 27 patients, 25 eases were given total resection, 2 eases were given subtotal resection, the rate of totle resection was 92.6% （25/27）. Postoperative improvement in clinical symptoms was not obvious, the median sur- vival time of 27 patients were 10.0 months. Conclusion DTI can be a good indication of white matter fibers traveling, can distinguish patients with high-grade glioma tumor lesions, perifoeal edema and normal white matter, provide a rea- sonable surgical approach for the surgeon, provide adequate assurance for precise intraoperative image guidance, so the surgeon should remove the tumor tissue in brain function without structural damage as much as possible, prolong sur- vival time of patients.