弥散张量成像引导脑功能区胶质瘤手术的价值研究

Study on the value diffusion tensor imaging-guided function area glioma surgery

目的探讨磁共振弥散张量成像(DTI)在脑功能区胶质瘤手术治疗中的价值。方法回顾性分析我院分别采用传统手术治疗和DTI引导手术治疗的脑功能区胶质瘤患者,且随访时间≥24个月。其中观察组21例,术前行增强MRI和DTI检查引导手术;对照组19例,采用传统手术,术前只行增强MRI。术后3天复查增强MRI检查肿瘤切除程度,术后1月用Karnofsky评分表评价患者生存质量,并追踪术后2年生存率。结果术前DTI通过ADC值、FA值等参数可对肿瘤评级,并显示正常脑组织和皮层下白质纤维束与肿瘤之间的关系引导手术治疗;术后观察组在肿瘤的Karnofsky评分、全切率和生存率上均高于对照组,差异有统计学意义(P<0.05)。结论 DTI有助于脑功能区肿瘤的术前分级评估和手术方案的制定;为术中最低程度破坏功能纤维束而最大程度切除肿瘤提供影像学指导,提高患者的生存质量与时间。

Objective To explore the value of magnetic resonance diffusion tensor imaging （DTI）-guided function area glioma surgery.Methods We retrospectively analyzed effectiveness on patients with gliomas, who underwent the traditional surgical treatment and DTI-guided function area glioma surgery, respectively, with a period of more than 24 months of follow-up.The observation group consisted of 19 patients, who were all subjected to preoperative enhancement MRI and DTI-guided surgery.The control group included 21 patients, who all underwent the traditional surgery and the preoperative enhanced MRI.Three days post-operation, patients were subjected to the enhanced MRI to inspect the tumor resection, one month later, Karnofsky score was used to evaluate the quality of life of patients, and the survival rate was tracked for two years post-operation.Results Preoperatively, DTI application can be used for estimating the tumor grade by ADC and FA parameters and be displaying the relationship between the tumor and normal brain tissue as well as thehe white matter fiber for guiding the surgery.Postoperatively, the Karnofsky score, tumor resection rate and survival rate in observation group were higher than those in control group.The difference was statistically significant.Conclusion DTI is helpful for the preoperative evaluation of tumor classification in brain function area and surgical plan formulation as well as for the intra-operative minimum damage of function of fiber bundles, thereby providing the maximum degree of guidance for the removal of the tumor and improving patients＇ quality of life and time.