摘要
目的脑肿瘤外科手术的原则之一是最大限度地切除肿瘤,同时保留重要的白质纤维束。利用弥散张量纤维束成像(diffusion tensor tractography,DTT)技术可在术前探讨脑肿瘤对白质纤维束的影响,术后评估纤维束的改变。文中探讨DTT在累及白质纤维束的脑肿瘤手术前后的应用。方法对11例脑肿瘤患者行弥散张量成像(diffusion tensor imaging,DTI),显示部分各向异性(fractional anisotropy,FA)图、方向编码彩色(directionally encoded color,DEC)图,分别测量锥体束及胼胝体患侧与健侧相应位置的FA值及表观弥散系数(apparent diffusion coefficient,ADC)值,用配对t检验进行比较,重建锥体束与胼胝体纤维手术后再次行DTI检查。结果锥体束及胼胝体患侧与健侧相应位置的FA值及ADC值差异有显著统计学意义(P<0.05)。患侧FA值降低,ADC值升高。在11例患者中累及椎体束的10例按纤维束与肿瘤的关系分为3型:Ⅰ型,纤维束仅有移位;Ⅱ型,纤维束移位伴侵润破坏;Ⅲ型,纤维束仅有侵润破坏。属Ⅰ型的1例术后移位有恢复;属Ⅱ型的6例术后移位有恢复而纤维破坏未能恢复,其中3例纤维束与术前比较有较大缺损,3例中有2例术后肌力明显降低;属Ⅲ型的3例术后纤维束与术前相比无明显变化。累及胼胝体的10例中,1例属Ⅰ型;1例属Ⅱ型;8例属Ⅲ型。结论 DTT可显示脑肿瘤与相关白质纤维束的关系,手术前后纤维束的变化与临床表现明显相关。
Objective Preserving vital tracts while maximizing tumor resection is one of the principles in brain tumor surgery.Diffusion tensor tractography（DTT） can be used to explore the influence of brain tumors on the white matter fiber bundle and evaluate postoperative changes of the fiber bundle.This study aimed to investigate pre-and post-operative application of DTT in brain tumor surgery.Methods Eleven patients with brain tumors underwent DTI for the measurement of the fractional anisotropy（FA） and apparent diffusion coefficient（ADC） of the injured side and uninjured side in the pyramidal tract and corpus callosum.The pyramidal tract and corpus callosum were reconstructed,followed by another DTI.Results There were statistically significant differences in FA and ADC between the injured side and uninjured side in the pyramidal tract and corpus callosum（P0.05）.FA was decreased while ADC increased obviously in the injured side.Based on the relationship between the tract and tumors,the 10 cased that involved the white tract could be classified into three types： type Ⅰ,simple displacement（n=1）,recovered after surgical reconstruction;type Ⅱ,displacement with disruption（n=6）,displacement reduced but disruption unimproved;and type Ⅲ,simple disruption（n=3）,without any improvement.Of the 10 cases involving the corpus callosum,1 fell into type Ⅰ,1 type Ⅱ,and 8 type Ⅲ.Conclusion DTT allows of visualization of the exact location of tumors relevant to the white matter tract.Postoperative changes of the fiber bundle are obviously correlated with the clinical manifestation of the tumor.
出处
《医学研究生学报》
CAS
2010年第9期943-949,共7页
Journal of Medical Postgraduates
基金
南京军区南京总医院科研基金(2005104)
