磁共振功能成像在胶质瘤外科治疗中的应用  

Preoperative Assessment of Brain Gliomas by Multiform Functional Magnetic Resonance Imaging Techniques

作　　者：尚寒冰[1] 赵卫国[1] 缪飞[2] 吴志远[2] 濮春华[1] 蔡瑜[1] 李宁[1] 朱军[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,上海200025 [2]上海交通大学医学院附属瑞金医院放射科,上海200025

出　　处：《中国临床神经外科杂志》2008年第12期712-716,共5页Chinese Journal of Clinical Neurosurgery

基　　金：上海市科委"登山计划"资助项目(No.064119516)

摘　　要：目的探讨磁共振波谱分析(MRS)、血氧水平依赖成像(BOLDI)以及弥散张量成像(DTI)在脑胶质瘤外科治疗中的作用。方法23例脑胶质瘤患者术前行常规MRI、1HMRS、DTI及BOLDI检查,根据术前影像学评估,设计手术方案切除肿瘤,并与术后病理及随访结果进行对比。结果①1HMRS表现为NAA峰降低,Cho峰升高,Cho/Cr、Cho/NAA比值升高,NAA/Cr比值降低。高级别胶质瘤Cho/Cr、Cho/NAA、LL/Cr比值和Cho值均显著高于低级别胶质瘤(P<0.01),且常出现Lip峰。②BOLDI表现为手运动功能区被肿瘤挤压、移位者5例,其中2例移向后方,2例移向外侧,1例移向前方。③DTI中表观弥散系数(ADC)和分数各向异性(FA)图可明确区分正常脑白质、水肿区和肿瘤边缘,并可在轴位像上观察白质纤维束被推移、浸润和破坏的程度。纤维束重建后,表现为浸润+破坏者5例,推移+破坏者4例,推移+浸润者11例,单纯推移者3例。④肿瘤全切6例,近全切8例,大部切除9例,所有患者术后无新发神经功能缺失。出院时KPS评分除1例患者60分外,其余患者均在90分以上。结论综合运用多种磁共振功能成像技术可从解剖、代谢等多方面对胶质瘤进行术前评价,以此明确诊断,可指导外科治疗,提高手术疗效,减少术后并发症。Objective To evaluate the value of multiform functional magnetic resonance imaging techniques including magnetic resonance spectroscopy （MRS）, blood oxygen level-dependent imaging （BOLDI） and diffusion tensor imaging （DTI） to preoperative assessment of brain gliomas. Methods The cerebral ^1HMRS, BOLDI and DTI were performed before the operation in 23 patients with cerebral gliomas. The characteristics of the images were observed and was compared with histopathologieal characteristics. Results ①^1HMRs showed that there is significant elevation of the ratio of choline （Cho） to ereatine （Cr）, the ratio of Cho to N-aeetylaspartate （NAA） and Cho peak, and significant depression of the NAA peak in gliomas compared to normal brain tissues. The ratios of Cho to Cr, Cho to NAA and [lactic acid ＋ lipid （LL）] to Cr were significantly higher in the high-grade gliomas, where the lipid peak appeared, than those in the low-grade gliomas （P〈0.01）. ② A motor activation scan was achieved by using a motor task paradigm in 20 patients. Deformation and displacement of the motor activations were found in 5 patients. ③The margin of tumor, edema region and peritumoural white matter were identified by apparent diffusion coefficient （ADC） and fractional anisotropy （FA） maps. On axial DTI, the disruption and infiltration of the white matter tracts were observed in 5 patients, disruption and displacement in 4, infiltration and displacement in 11, and displacement in 3.④The tumors were totally resected in 6 patients, subtotally in 8, and partially in 9. No new neurological deficit occurred in all the patients after the operation. Every one of these patients, except one patient whose KPS was 60 point, achieved above 90 points of KPS. Conclusions The many-sides assessment of the brain gliomas may be preoperatively performed by MRS, BOLDI, and DTI techniques. The mapping of motor activations and white matter tracts is helpful to maximal resection of the lesions and decrease in damage to the ne

关 键 词：胶质瘤 治疗 磁共振波谱 血氧水平依赖成像 弥散张量成像 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]