弥散张量纤维束成像在涉及锥体束的胶质瘤手术中的应用

目的探讨弥散张量纤维束成像(DTT)在涉及锥体束的胶质瘤手术中的应用价值。方法对10例涉及锥体束的胶质瘤患者,术前行核磁检查及弥散张量纤维束示踪图,观察锥体束的结构、走形及其与肿瘤的毗邻关系,制定合理的手术方案。术后再行DTT以评价手术对锥体束的影响,并于入院及出院时行KPS评分以评估预后。结果DTT显示出锥体束与肿瘤的位置关系,10例患者中,2例表现为锥体束单纯移位(术后移位均减轻),术前、术后KPS评分平均为80和90;2例表现为锥体束单纯破坏(术后1例部分恢复,1例未恢复),术前、术后KPS评分平均为70和85;6例表现为锥体束移位伴破坏(术后2例移位及破坏均部分恢复,3例移位恢复,1例均未恢复),术前、术后KPS评分平均为71和76。结论DTT可明确锥体束与肿瘤的空间毗邻关系,为术前制定合适的手术方案及术后评价患者神经功能状态提供了依据。

Clinical application of diffusion tensor tractography in patients with brain gliomas involving pyramidal tracts

Objective To explore the role of diffusion tensor tractography(DTT) in preoperative planning and functional outcom evaluation of the patients with brain gliomas involving pyramidal tracts.Methods Ten patients with brain gliomas involving pyramidal tracts were included.They underwent routine MRI examination and DTT.The exact relationship between the pyramidal tracts and tumors was demonstrated,which was used to optimize the preoperative planning.After operation,DTT was performed again to evaluate the influence of the pyramidal tracts by surgery.The preoperative and postoperative KPS were respectively acquired to evaluate the functional condition of patients.Results The relationship between the pyramidal tracts and the tumor was successfully displayed.In 10 patients,2 cases were simple displacement,the pre-KPS and post-KPS were 80 and 90,respectively.2 cases were simple disruption,the pre-KPS and post-KPS were 70 and 85,respectively.Other 6 cases were displacement with disruption,the pre-KPS and post-KPS are 71 and 76,respectively.Conclusion Diffusion tensor tractography can display the exact relationship between pyramidal tracts and tumors.It was a beneficial technique not only in neurosurgical planning but also in postoperative assessment.