弥散张量成像对基底节区胶质瘤手术的临床意义  

The clinical significance of Diffusion Tensor Imaging for resection of basal ganglia region Gliomas

作　　者：周德祥[1] 林晓风[1] 詹升全[1] 周东[1] 唐凯[1] 王鹏[1] 郭文龙[1] 秦琨[1] 李炎稳[1] 毛承亮[1] 郑聪颖[1] 彭超[1] 

机构地区：[1]广东省人民医院//广东省医学科学院神经外科,广东广州510080

出　　处：《分子影像学杂志》2015年第4期313-315,共3页Journal of Molecular Imaging

基　　金：国家自然科学基金青年基金(81201995);广东省科技计划项目资助(2012B031800165)

摘　　要：目的探讨弥散张量成像(DTI)对指导手术切除基底节区胶质瘤及降低致残率的临床意义。方法收集2009~2014年间我科收治的48例基底节区胶质瘤患者,术前行MRI+DTI,用纤维束示踪方法重建出锥体束,明确肿瘤和锥体束的三维空间结构关系,以避开锥体束设计手术入路,按纤维束受肿瘤侵袭程度指导手术切除肿瘤范围,术后评估神经功能状况。同时选取同期30例基底节区胶质瘤未行DTI的手术患者作为对照组,了解两者两组全切率及术后4周KPS评分的差异。结果对照组镜下全切19例,次全切7例,部分切除4例,全切率63.3%;DTI组镜下全切29例,次全切13例,部分切除6例,镜下全切率60.4%,两组镜下全切率比较,P>0.05,差别无统计学差异;对照组KPS评分为77.67±19.09分;DTI组KPS评分为87.29±14.84分,两组KPS评分比较,P<0.05,差别有统计学意义。结论术前DTI检查对指导手术切除基底节区胶质瘤有重要临床意义,起到降低患者致残率和提高术后生存质量的作用,但无提高肿瘤全切率。Objective To explore the clinical significance of diffusion tensor imaging(DTI) of instructing to remove basal ganglia region Gliomas and decreasing the disability after operation. Methods Fourty-eight cases of basal ganglia region Gliomas which were carried MRI and DTI scanning before operation from 2009 to 2014 were as the DTI Group. While 30 cases in controlled group were only took MRI scanning before operation in the same term. In the DTI group, pyramidal tract was reconstructed by the technique of Fiber Tracking and the 3D structure relationship between the fiber tracts and the tumor was known well before operation. Then, the surgical approach was chosen according to its away from the pyramidal tract.Otherwise, resection range of the tumor tissue was decided according to invasive severity of the pyramidal tract by the tumor.The difference of the rate of resection and the KPS scores were compared between two groups at four weeks after operation.Results In the controlled group, the rate of total resection, subtotal resection and biopsy was respectively 63.3%(19/30), 23.3%(7/30) and 13.3%(4/30); While in the DTI group, they were respectively 60.4%(29/48), 27.1%(13/48) and 12.5%(6/48).There was no significant difference in total resection between these two groups(P>0.05). There was a significant difference in KPS scores between two groups(P<0.05) due to compare 87.29 ± 14.84 in the DTI group with 77.67 ± 19.09 in the controlled group. Conclusion DTI presurgically is good for instructing to remove basal ganglia region Gliomas due to its decreasing the disability rate and increasing living quality of patients after operation. But it did not contribute to total resection of tumors.

关 键 词：弥散张量成像 胶质瘤 基底节 手术 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]