高分辨弥散张量示踪用于鞍区肿瘤患者前视路的形态学研究

目的：探讨鞍区肿瘤患者前视路高分辨弥散张量纤维束示踪（DTT）的影像特点及其与视觉功能、预后的关系。方法：系列病例研究。选取2015年11月至2017年6月在福建医科大学福总临床医学院经手术切除的鞍区肿瘤患者21例，在术前1周及术后4个月行前视路高分辨弥散张量成像（DTI）扫描， 并通过DTT重建白质纤维束，观察纤维束走行及完整性情况。采用视觉功能障碍（VIS）评分进行视 觉功能的评估。采用Ｍann-Whitney U检验、Fisher精确概率法对数据进行统计学分析。结果：DTT 可清晰观察21例鞍区肿瘤患者前视路白质纤维束的中断或完整现象，稀疏或饱满情况，也可以显现 前视路白质纤维束与鞍区肿瘤之间的空间位置关系（中断型8例，连续型13例）。术前前视路白质纤 维束不同形态患者的VIS评分差异无统计学意义（Z=-0.679，P=0.497），连续型和中断型与视觉功能预后相关，前视路白质纤维束形态完整型的患者术前视觉功能状态及术后4个月时的预后均优于中断型（P=0.014）。结论：高分辨DTT能直观显示前视路白质纤维束的形态，并对鞍区肿瘤患者视觉功 能的预后判断具有参考价值。

Application of High-Resolution Diffusion Tensor Tracing in the Anterior Visual Pathway Morphology of Patients with Sellar Tumors

Objective: To investigate the imaging characteristics of the high-resolution diffusion tensor tracting (DTT) on the anterior visual pathway of sellar region tumors and its relationship with visual function and prognosis. Methods: This was a cases series study. From November 2015 to June 2017, 21 cases of sellar region tumors were surgically resected in the Fuzong Clinical Medical College of Fujian Medical University. High resolution diffusion tensor imaging (DTI) scans were performed one week before surgery and three months after surgery, and white matter fibers were reconstructed by DTT to observe the course and integrity of the fibers. A visual impairment score (VIS) was used to evaluate visual function. The data were analyzed by a Mann Whitney U test and Fisher exact probability test. Results: DTT could clearly show the interruption or integrity and sparseness or fullness of the white matter fiber bundle of the anterior visual pathway in 21 patients with sellar region tumor. It could also show the spatial position relationship between the white matter fiber bundle of the anterior visual pathway and sellar region tumor (8 cases of the interruption type, 13 cases of the continuity type). There was no significant difference in the vision score of patients with different shapes of white matter fiber bundle before surgery (Z=-0.679, P=0.497). Both the continuous type and interrupted type were related to the prognosis of visual function. The patients with an intact shape of the anterior visual tract had a better visual function status before surgery and better pre- and post-surgery at 4 months after the operation (P=0.014). Conclusions: High resolution DTT can visually display the shape of the anterior optic tract, and has a reference value for predicting the prognosis of visual function in patients with sellar region tumors.