大脑胶质瘤相毗邻皮质脊髓束的纤维束成像与临床体征的对比分析

目的:对比分析胶质瘤相毗邻皮质脊髓束纤维束成像与患者的临床体征,探究皮质脊髓束纤维束成像的精确性。方法:2006年8月～2008年9月,16例脑深部占位术后病理证实为胶质瘤患者,术前行常规磁共振序列及DTI序列扫描。在FA图上,以一侧大脑脚为种子兴趣区(ROI)以及同侧的内囊后肢为第二兴趣区,FA阈值设置为0.2,采用连续追踪法对双侧的大脑皮质脊髓束进行重建,分析其走行及完整性,对患侧皮质脊髓束的状态进行评估,并与患者的临床体征进行对比分析。结果:16例大脑胶质瘤相毗邻皮质脊髓束的纤维束成像分析发现:皮质脊髓束仅有移位的3例;受浸润9例;完全破坏4例。皮质脊髓束移位3例,患者对侧肢体肌力均正常或者轻度的下降。皮质脊髓束受浸润9例,其中对侧上肢轻度偏瘫2例,中度偏瘫4例,重度偏瘫3例;对侧下肢轻度偏瘫4例,中度偏瘫3例,重度偏瘫2例。皮质脊髓束破坏4例,对侧上下肢肌力均重度偏瘫。结论:弥散张量纤维束成像能够较为准确的反应出皮质脊髓束状态的改变,可用于临床手术计划系统的制定。

Diffusion tensor fober tracking of the corticospinal tract adjacent to gliomas

Objective：To validate the accuracy of diffusion tensor fiber tracking （DTT） by correlating appearances of the corticospinal tract adjacent to gliomas on diffusion tensor fiber tracking imaging with the clinical symptoms. Methods：We examined 16 patients with histologically confirmed brain gliomas in deep brain from August 2006 to September 2008. The corticospinal tract （CST） was reconstructed with amethod,which was so-called continuous tracking （FACT） algorithm with threshold of FA was 0.20. The tracking algorithm was initiated from a user-defined region of interest （ROI）. The first ROI was placed on the cerebral peduncle; the second ROI was placed on the posterior limb of the internal capsule on FA map. The integrity of CST was investigated and to be correlated with the clinical symptoms. Results：Of 16 patients,3 cases were displaced,9 infiltrated and 4 destroyed according to fiber tracking results of CST. For the 3 displaced cases,all the patients＇ motor strength was normal or mild hemiparesis. For the 9 infiltrated cases,2 patients had upper extremities mild hemiparesis,4 patients had upper extremities moderate hemiparesis and 3 patients had upper extremities evere hemiparesis; 4 patients had lower extremities mild hemiparesis,3 patients had lower extremities moderate hemiparesis and 2 patients had lower extremities severe hemiparesis. For the 4 destroyed cases,all the patients＇ motor strength was severe hemiparesis. The appearances of the corticospinal tract on DTT were associated with the clinical symptoms. Conclusion：DTT can provide accurate information of the integrity of corticospinal tracts and it is helpful to design surgical planning.