多模态脑功能定位在胶质瘤中的临床应用

目的:探讨术前多模态磁共振弥散张量成像（diffusion tensor imaging，DTI）脑功能定位技术在脑胶质瘤手术中的应用价值。方法:选择2016年1月至2017年3月在我院接受手术治疗的25例脑胶质瘤患者作为研究对象，所有患者术前均利用核磁共振DTI技术在导航工作站将肿瘤、神经纤维束及肿瘤周边的结构进行重建，并进行3D打印，术前根据3D打印出来的模型进行模拟手术，术中避开重要结构切除肿瘤，手术入路设计上可以避免损伤脑功能区及肿瘤周边的重要结构，通过多模态定位技术进行脑胶质瘤手术。结果:术前导航定位准备工作13～19 min，平均（15.2±1.4） min；iMRI扫描准备时间4～7 min，平均（5.8±0.8） min。25例患者全切21例，占84％；次全切或部分全切4例，占16％。术后KPS评分与术前相比较显著升高（P<0.05）。术后1年生存23例，生存率92％。结论:术前多模态磁共振DTI脑功能定位技术用于脑胶质瘤的手术治疗可通过影像融合和重建，提供准确的肿瘤与功能区结构的关系，准确显示肿瘤位置，为肿瘤的精准切除提供了保障。

Clinical application of multimodal brain function localization in glioma

Objective:To evaluate the value of preoperative multimodal magnetic resonance diffusion tensor imaging（DTI） brain function localization technique in glioma surgery.Methods:25 patients with glioma who underwent surgery in our hospital from January 2016 to March 2017 were selected as subjects.All patients underwent pre-operative use of NMR DTI technology to reconstruct the structure of tumors，nerve fiber bundles and tumors in the navigation workstation，and 3D printing.Simulated surgery based on 3D printed models before surgery，performed tumor resection after avoiding important structures.The surgical approach can avoid damage to brain functional areas and important structures around the tumor，and perform glioma surgery through multimodal localization technology.Results:The preoperative navigation and positioning preparation work was 13~19 min，with an average of （15.2±1.4）min，and the iMRI scan preparation time was 4~7 min，with an average of （5.8±0.8） min.21 patients underwent total resection，accounting for 84%.4 patients sub-full cut or partial resection，accounting for 16%.The postoperative KPS score was significantly higher than that before surgery（P<0.05).23 patients survived 1 year after operation，and the survival rate was 92%.Conclusion:Preoperative multimodal magnetic resonance DTI brain function localization technique for glioma surgery can provide accurate tumor and functional area structure and accurate display of tumor location through image fusion and reconstruction.It provides a guarantee for precise resection of the tumor.