摘要
目的探讨在脑胶质瘤分级诊断中应用磁共振弥散张量成像(diffusion tensor imaging,DTI)联合弥散张量纤维束成像(diffusion tensor tractography,DTT)的临床价值。方法选择2016年1月-2017年6月就诊于邯郸市眼科医院并经病理证实为脑胶质瘤的80例患者作为研究对象。根据恶性程度将研究对象分为低级别组(n=38)和高级别组(n=42)。分别测量2组患者瘤周水肿带、瘤体的平均各向异指数(average fraction anisotropy,rFA)值、表观扩散系数(Apparent diffusion coefficient,rADC)值,并通过DTT对肿瘤周围白质纤维束发生的变化进行观察。结果同组患者中,周围水肿带、瘤体rFA值均明显低于健康对照区,差异具有统计学意义(P<0.05),低级别组与高级别组患者在3个部位的rFA值未见明显差异(P>0.05);同组患者中,周围水肿带、瘤体rADC值均明显高于健康对照区,差异具有统计学意义(P<0.05),组间对比,2组患者健康对照区无明显差异(P>0.05),但周围水肿带及瘤体的rADC值有明显差异,差异有统计学意义(P<0.001);DTT结果显示,相较于低级别组,高级别组出现纤维束浸润、推移和破坏的程度更为严重(Z=4.278,P<0.001)。而通过与病理检查的金标准进行比较,DTI的诊断符合率93.75%(75/80)与DTI+DTT的诊断符合率96.25%(77/80)差异无统计学意义(P>0.05)。结论DTI联合DTT尚不足以明确脑胶质瘤的分级诊断,但是却能够全面详细地显示出周围脑白质神经纤维改变、与肿瘤的关系,从而为胶质瘤术前评估、手术结果观察以及远期预后判断提供科学有效的影像学依据,仍然值得临床借鉴参考。
Objective To explore the clinical value of magnetic resonance diffusion tensor imaging(DTI)combined with diffusion tensor fiber bundle imaging(DTT)in the grading diagnosis of gliomas.Methods Eighty patients with gliomas confirmed by pathology in the Handan Eye Hospital from January 2016 to June 2017 were selected as subjects.According to the degree of malignancy,the subjects were divided into low-level group(n=38)and high-level group(n=42).The mean anisotropy index(average fraction anisotropy,rFA)and apparent diffusion coefficient(rADC)of peritumoral edema zone and tumor were measured and analyzed,and the changes of white matter fiber bundles around the tumor were observed by DTT.Results In the same group,the rFA values of peritumoral edema zone and tumor body in the two groups were significantly lower than that in the healthy control group(P<0.05),but there was no significant difference between the low grade group and the high grade group(P>0.05).In the same group,the rADC values of the peritumoral edema zone and the tumor body in the two groups were significantly higher than that in the healthy control area(P<0.001).There was no significant difference between the two groups in the healthy control area(P>0.05),but there was significant difference in the surrounding edema zone and tumor body between the two groups(P<0.05).The results of DTT showed that the degree of infiltration,progression and destruction of fiber bundles in the high grade group was more serious than that in the low grade group(Z=4.278,P<0.001).Compared with the gold standard of pathological examination,the diagnostic coincidence rate of DTI diagnosis was 93.75%(75/80)and that of DTI+DTT was 96.25%(77/80),and the difference was not statistically significant(P>0.05).Conclusion DTI combined with DTT is not enough to determine the grading diagnosis of gliomas,but it can show the changes of nerve fibers in peripheral white matter and the relationship between gliomas and tumors in detail,so as to provide scientific and effective imaging basis for preoperative evaluation,observation of surgical results and longterm prognosis of gliomas,which is worthy of clinical reference.
作者
冯俊峰
FENG Junfeng(CT Room Handan Ophthalmology Hospital/the Third Hospital of Handan City,Hebei Handan 056001,China)
出处
《新疆医科大学学报》
CAS
2020年第6期782-785,791,共5页
Journal of Xinjiang Medical University
基金
邯郸市科技计划项目(2017ZC067)。
关键词
弥散张量成像
弥散张量纤维束成像
脑胶质瘤
diffusion tensor imaging(DTI)
Diffusion tensor fiber bundle imaging(DTT)
glioma
