MRI DTI联合血氧水平依赖功能成像在星形细胞瘤术前的研究

Application of diffusion tensor imaging and MRI in pre-surgical planning of brain neoplasms with 3.0T MRI

目的探讨3.0T磁共振弥散张量成像（DTI）技术联合功能磁共振成像（fMRI）在星形细胞瘤与邻近脑白质纤维束解剖关系术前计划中的作用。方法对22例星形细胞瘤患者术前行常规MRI平扫,增强扫描及DTI技术fMRI检查,原始数据采集后进行图像分析处理,分别获得各项异性图（FA图）,彩色编码张量图及脑白质纤维束图,并测定肿瘤的病灶区表观弥散系数（ADC值）及灶周水肿区各项异性分数（FA值）。分析肿瘤与相邻脑白质解剖关系,并对患者手术前后的临床症状进行评价。结果不同级别星形细胞瘤的肿瘤病灶区和灶周水肿区与正常白质区的ADC值和FA值存在差异,有统计学意义（P〈0.05﹚。白质纤维束可见受压、移位、浸润及破坏三种改变。4例Ⅰ～Ⅱ级星形细胞瘤推移相邻脑白质纤维束;8例Ⅱ～Ⅲ级星形细胞瘤侵润脑白质;10例Ⅲ～Ⅳ级星形细胞瘤破坏相邻脑白质纤维束。DTI图可以清晰显示运动区锥体束形态变化及与肿瘤之间的关系,在此基础上指导手术,效果满意。结论磁共振DTI技术联合fMRI是目前唯一在活体无创、三维清晰星形细胞瘤与周围白质纤维束的关系,由于二者的联合应用不仅能够显示大脑重要功能激活区在病理情况下的移位和改变,同时还能显示肿瘤与重要功能区和白质纤维束结构的关系,具有重要意义。

Objective To explore the 3.0T magnetic resonance diffusion tensor imaging（DTI）and fMRI between brain neoplasms and adjacent brain white matter fiber tracts anatomical relationship in the role of Pre-surgical panning.Methods36 cases of brain neoplasms patients were taken the preoperative routine MRI scan,enhanced scan and DTI technology inspection.After the original data acquisition processing and image analysis,all the members of the fractional anisotropy（FA）,color-coded tensor figure,cerebral white matter fiber tracts,the determination of tumor lesion area of apparent diffusion coefficient（ADC）values,and peritumoral edema area all the members of the opposite fractional anisotropy（FA）were aquired,respectively.The relationship of the tumor and adjacent cerebral white matter anatomic were analyzed.And the clinical symptoms of patients before and after surgery were evaluated.Results The ADC and FA value,between different grade of Astrocytoma lesion area,peripheral edema area and normal white matter were significant differences（P〈0.05）.The changes which contained compression,displacement,infiltration,and destroy,were visible in the white matter fiber tracts.4cases of grade Ⅰ ～ Ⅱ Astrocytoma compressed adjacent cerebral white matter fiber tracts,8cases of gradeⅡ～ Ⅲ Astrocytoma invaded the brain white matter;10cases of gradeⅢ ～ Ⅳ Astrocytoma destroyed of adjacent cerebral white matter fiber tracts.DTI chart can clearly display the relationship of the changes between motor area pyramidal tract morphological and the tumor.On this basis to guide the operation,the effect was satisfactory.Conclusion DTI,which is currently the only noninvasive technology in vivo,can show the three dimensional white matter fiber tracts surrounding brain tumors clearly.DTI and fMRI shows not only shift or change of brain＇s important function area in the pathological circumstances but also the relations among the tumors,the cerebral important function area and the white matter.In this sense,this method is of great significance.