扩散张量成像及扩散张量纤维束成像对累及脑干肿瘤围手术期评估的应用研究  

The application of diffusion tensor imaging and diffusion tensor tractography in the perioperative assessment of tumors involving brainstem

作　　者：郭翠萍[1] 张雪林[2] 吕晓飞[3] 邱迎伟[2] 韩路军[3] 熊伟[2] 汪丹凤[2] 

机构地区：[1]郑州市儿童医院放射科,450053 [2]南方医科大学附属南方医院影像中心,广州510515 [3]中山大学附属肿瘤防治中心影像与微创介入中心

出　　处：《中华放射学杂志》2014年第4期265-269,共5页Chinese Journal of Radiology

摘　　要：目的 探讨MR扩散张量成像（DTI）及扩散张量纤维束成像（DTT）技术对累及脑干肿瘤围手术期的应用价值.方法 连续收集经住院手术并病理证实的35例累及脑干肿瘤患者,同时选取与患者性别及年龄层次匹配的35名健康志愿者作为正常对照.对所有患者及正常对照行DTI扫描,利用DTI及DTT技术评估患者皮质脊髓束（CST）及内侧丘系（ML）损伤程度并分级,同时评价患者神经功能障碍等级.采用Spearman相关性分析评价CST及ML损伤分级与肢体运动、感觉功能障碍之间的相关性.结果 神经纤维损伤程度分级中,CST正常、移位、水肿或浸润、破坏分别为9、9、1 1、6例,ML分别为8、9、15、3例.运动功能分级中,无缺失、轻度缺失、中度缺失分别为20、11、4例;感觉功能分级中,无缺失、轻度缺失、中度缺失分别为21、6、8例.患者运动功能障碍与CST损伤程度、感觉功能障碍与ML损伤程度均呈正相关（r值分别为0.786、0.686,P值均＜0.01）.所有肿瘤与CST及ML的位置关系在图像上均可得到良好显示,制定了对应的手术方案.所有患者术后均未出现新的神经功能障碍.结论 DTI及DTT技术可用于累及脑干肿瘤围手术期评估CST及ML的损伤程度,并能直观显示脑干CST及ML与肿瘤的位置关系,对脑干纤维束的术中保护、术后评估恢复状况有重要的临床意义.Objective To explore the value of diffusion tensor imaging （DTI） and diffusion tensor tracography （DTT） in assessment of Corticospinal tract （CST） and medial lemniscus （ML） in tumors involving brainstem.Methods A total of 35 cases with pathologically confirmed tumors involving brainstem were collected,and 35 volunteers matched with genders and ages were recruited as the normal group.DTI scanning was performed on all the patients and controls.The damage degrees of CST and ML were evaluated and graded by DTT,and the dysfunction degrees were evaluated for the patients.Spearman correlation was used to statistically analyze the relationships of limb movement,sensory dysfunction and CST and ML damage.Results According to the rating results,normal findings,shifting,edema or infiltration and damage of CST was found in 9,9,11,and 6 cases respectively.They were 8,9,15,3 cases for ML.Motor function was normal in 20 cases,slightly defective in 11 cases,and moderate defective in 4 cases.Sensory function was normal in 21 cases,slightly defective in 6 cases,and moderate defective in 8 cases.The patients＇ dyskinesia and CST damage degree,sensory dysfunction and ML damage degree were positively correlated （r was 0.786 and 0.686 respectively,P ＜ 0.01）.The position relationship among tumor and CST and ML could be well displayed on images.None of the patients showed new symptoms of dysneuria after surgery.Conclusions DTI and DTT technology can be used to evaluate CST and ML damage degree in tumors involving brainstem.They can display the position relationship between tumor and the brainstem CST and ML,which is important in protecting the brainstem fiber tract during operation and evaluating the recovery after the operation.

关 键 词：磁共振成像 弥散 脑干肿瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学]