弥散张量磁共振成像在脑实质内肿瘤手术中的作用

目的研究弥散张量磁共振成像(DTI)在认识脑实质内肿瘤的生长方式和显微手术中的作用。方法脑实质内肿瘤患者41例,随机分为对照组23例,研究组18例。手术前、后行常规MR及DTI检查。所有患者手术均在显微操作下进行。两组病例依据不同的影像选择手术入路。比较两组患者手术结果、DTI影像变化以及手术前后神经功能改变。结果21例胶质母细胞瘤和1例室管膜母细胞瘤位于中央区及附近、颢枕部和颞叶深部,术前DTI表现肿瘤仅将传导束推移；2例转移瘤位于颞枕部,术前DTI显示视放射没有解剖移位,而是部分缺如,提示肿瘤对其有侵犯；8例星形或少枝胶质瘤位于额、颞、顶、枕部,术前DTI提示传导束未出现移位、变形,表现为经过肿瘤部位的传导束中断,这说明肿瘤对其侵犯、破坏；其余肿瘤未涉及到重要传导束。术后DTI显示对照组5例患者因手术导致传导束受损,研究组2例损伤。传导束损伤的患者均出现相应的神经功能障碍。结论DTI能够清楚可靠的显示肿瘤与白质传导束的关系,有利于确定手术方案,术中保护功能传导束,提高肿瘤切除率。

The role of diffusion-tensor imaging in the operation of the patients with brain tumors

Objective To study the role of diffusion-tensor imaging (DTI) in realizing growing pattern and resection of intra-axial brain tumors.Methods 41 cases with brain turnors underwent conventional MR and DTI imaging examinations and their neuro-function were evaluated before and after operation.The cases were divided into control group (23 cases) and study group (18 cases) randomly.After selection of operative approach based on conventional MRI and DTI respectively,all patients were operated under the microscope.The operating result,the change of neuro-function and the alternation of DTI were compared.Results The tumors were totally removed in 17 cases and 16 cases,subtotally in 4 cases and 1 case,partially in 2 cases (1 died) and 1 case in the control group and the study group,respectively. Histological results confirmed glioblastoma 25 cases,metastic tumor 5 cases,ependymoblastoma 1 case, oligodendroglioma 3 cases,astrocytoma and anaplastic astrocytoma 7 cases.Before operation,DTI showed that white matter tracts were only shifted in 21 cases ofglioblastoma and I case of ependymoblastoma which located in eloquent area,temporal-occipital part,deep temporal lobe and partially interrupted by tumors in 2 cases of metastic tumors located in temporal-occipital part and 8 cases of astrocytoma or anaplastic astrocytoma located in cerebral hemisphere.Other tumors did not invade white matter tracts.Postoperatively, DTI showed white matter tracts were damaged in 5 cases in the control group and 2 cases in the study group and all of the 7 patients developed corresponding disability.Conclusion DTI can evidently exhibit the relation between white matter tracts and brain tumor in the patients so that DTI contributes to a great extent to surgical planning,intraoperative preserve of white matter tracts as well as the increased proportion of tumor resection.