3.0T磁共振弥散张量成像在胶质瘤切除术中的应用价值

目的探讨3.0T磁共振弥散张量成像(Diffusion Tensor Imaging,DTI)技术在手术切除胶质瘤中的应用价值。方法对28例胶质瘤患者随机分为试验组(常规MR序列及DTI序列扫描)和对照组(常规MR序列扫描),试验组患者应用DTI重建以有效锥体束(effetive fibers of pyramidal tract,EPT)为主的脑白质纤维束,优化手术入路,指导术中最大限度的切除肿瘤并保护EPT;对照组患者在常规磁共振图像指导下行肿瘤切除,两组胶质瘤患者均行术前、及术后3个月的DTI扫描,对扫描图像、肿瘤镜下全切率、术后致残率及患者Kamofsky生活状态评分(KPS)进行比较分析。结果 1对照组肿瘤镜下全切率57.2%。试验组64.2%(P0.05);2对照组术后致残率71.4%,试验组21.4%(P0.05);3预后评估:对照组KPS68.36±10.60。试验组KPS85.43±5.65(P0.05)。结论 DTI技术对于累及EPT的胶质瘤,术前可提供病灶与EPT间的三维解剖信息,指导术者最大范围切除肿瘤的同时,保护EPT。可明显降低术后致残率,改善患者术后生活质量。

The Application Value of 3.0T Magnetic Resonance Diffusion Tensor Imaging in the Surgical Resection of Gliomas

Objective To investigate the application value of 3.0 T magnetic resonance Diffusion Tensor Imaging (DTI) technology in the surgical removal of gliomas. Methods 28 cases of glioma patients were randomly divided into experimental group (conventional MR sequences and sequence of DTI scan) and the control group (conventional MR sequences scanning),the treatment group patients have the application of DTI reconstruction to effectively pyramidal tract(EPT) of cerebral white matter fiber tracts, with the optimal surgical approach, guiding intraoperative excision of tumor and maximum protection EPT; the control group patients have the tumor resection by guiding with the conventional magnetic resonance imaging, both of the groups were performed DTI scan 3 months before operation and 3 months after it. the scan images, the microscopic tumor patients with postoperative morbidity rate, and Kamofsky life status score (KPS) comparative were analyzed.Results (1) the control tumor microscopically the cutting rate was 57.2%. Experimental group 64.2% (P>0.05); (2) the control of postoperative morbidity was 71.4%, the experimental group 21.4% (P<0.05); (3) the prognosis assessment: the control group KPS68.36±10.60. Experimental group KPS 85.43 ±5.65 (P<0.05).Conclusion DTI technology can provide three-dimensional anatomical information between the lesions and EPT for gliomas involving EPT preoperatively, guiding the performer largest radius and the removal of the tumor at the same time, which can protect the EPT and significantly reduce postoperative disability rate and improve patient quality of life after surgery.