弥散峰度成像预测皮质脊髓束周围高级别胶质瘤患者肌力下降

目的 观察弥散峰度成像（DKI）预测皮质脊髓束（CST）周围高级别胶质瘤（HGG）患者肌力下降的价值。方法 纳入21例HGG累及CST走行区及其周围患者，比较患侧及健侧CST DKI定量参数的差异；根据手术前肢体肌力改变情况将患者分为正常组（n=14）及肌力下降组（n=7），比较组间Karnofsky功能状态（KPS）评分及CST DKI定量参数的差异。绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），评价CST相对定量参数预测患者肌力下降的效能。结果 与健侧比较，患侧纤维束数量、体积、各向异性分数（FA）、平均峰度（MK）、轴向峰度（AK）和径向峰度（RK）均显著降低（P均<0.05），而平均弥散系数（MD）及径向弥散系数（RD）均显著增高（P均<0.05）。肌力下降组KPS评分、相对FA（rFA）、相对MK（rMK）、相对AK（rAK）及相对RK（rRK）均明显低于正常组（P均<0.05），而相对MD（rMD）、相对轴向弥散系数（rAD）及相对RD（rRD）均明显高于正常组（P均<0.05）。各相对CST定量参数预测HGG患者肌力下降的效能均较高（AUC均高于0.850）。结论 肌力下降HGG患者肿瘤周围CST的DKI定量参数改变显著；术前DKI可用于预测患者肌力下降，并间接判断CST损伤。

Diffusion kurtosis imaging in predicting muscle strength decline in patients with high-grade glioma around corticospinal tract

Objective To observe the value of diffusion kurtosis imaging (DKI) in predicting muscle strength decline in patients with high-grade glioma (HGG) around corticospinal tract (CST). Methods A total of 21 patients with HGG involved in and around the CST walking area were enrolled. DKI quantitative parameters of CST were compared between the affected and healthy side. The patients were then divided into normal group (n=14) and muscle strength decline group (n=7) according to the changes of limb muscle strength before and after surgical operation, and Karnofsky performance status (KPS) score and quantitative DKI parameters of CST were compared between groups. The receiver operating characteristic (ROC) curves were plotted, and the areas under the curves (AUC) were calculated to evaluate the efficacy of the relative quantitative parameters of CST for predicting muscle strength decline. Results Compared with those of the healthy side, the number, volume of fiber bundles, fractional anisotropy (FA), mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK) of the affected side significantly decreased (all P<0.05), while the mean diffusivity (MD) and radial diffusivity (RD) significantly increased (all P<0.05). KPS score, relative FA (rFA), relative MK (rMK), relative AK (rAK) and relative RK (rRK) in muscle strength decline group were significantly lower than those in normal group (all P<0.05), and the relative MD (rMD), relative axial diffusivity (rAD) and relative RD (rRD) were significantly higher than those in normal group (all P<0.05). All relative CST parameters had high diagnostic efficacy for predicting muscle strength decline, with AUC higher than 0.850. Conclusion The quantitative DKI parameters of CST around tumor of HGG patients with muscle strength decline changed significantly. Preoperative DKI could be used to predict muscle strength decline in patients with HGG around CST, thereby indirectly judge CST injury.