弥散张量成像对颈髓髓内肿瘤手术切除程度判断的初步研究  

The role of diffusion tensor imaging in determining the degree of surgical resection of cervical spinal intramedullary tumors: a preliminary study

作　　者：孔德生[1,2] 刘伟豪 张耀武 贾文清 Kong Desheng;Liu Weihao;Zhang Yaowu;Jia Wenqing(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100070 [2]北京大学国际医院神经外科,102206

出　　处：《中华神经外科杂志》2021年第10期976-980,共5页Chinese Journal of Neurosurgery

基　　金：首都临床特色应用研究 (Z171100001017068)。

摘　　要：目的初步观察术前弥散张量成像(DTI)对颈髓髓内肿瘤手术切除程度的判断与肿瘤实际切除程度的符合情况。方法回顾性分析2018年10月至2020年8月在首都医科大学附属北京天坛医院神经外科接受治疗的15例颈髓髓内肿瘤患者的临床及影像学资料。术前根据DTI判断肿瘤的切除程度(Ⅰ~Ⅲ型),术中根据显微镜下所见(是否存在肿瘤-脊髓分界面)及神经电生理监测确定肿瘤的切除程度;术后1周根据颈椎MRI检查结果确定肿瘤的切除程度。采用McCormick分级标准评定患者的神经功能改变情况。结果术前DTI显示Ⅰ型肿瘤8例,均可以全切除;术后MRI显示均为全切除。DTI显示Ⅱ型肿瘤3例,均可全切除;术后MRI显示1例全切除,2例近全切除。上述11例患者均未发生手术相关的神经功能损伤。术前DTI显示Ⅲ型肿瘤4例,均不可切除;术后MRI显示3例近全切除,1例大部分切除;其中2例患者发生与手术相关的神经功能缺损。15例患者术后随访(12.5±1.5)个月,末次随访时,10例患者为McCormick分级Ⅰ、Ⅱ级,5例患者为Ⅲ、Ⅳ级。结论颈髓髓内肿瘤患者术前DTI的评估结果与实际切除程度符合情况较好。Objective To preliminarily explore the role of diffusion tensor imaging(DTI)in determining the degree of surgical resection of cervical spinal intramedullary tumors.Methods A retrospective analysis was conducted on the clinical and imaging data of 15 patients with cervical spinal intramedullary tumors who were treated at the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from October 2018 to August 2020.The degree of tumor resection was evaluated according to DTI before operation,and the degree of tumor resection during operation was determined according to the observation under the microscope(whether there was a tumor-spinal cord interface)and neuroelectrophysiological monitoring.At 1 week after the operation,the tumor resection was assessed according to the results of cervical MRI examination.The McCormick grading system was used to assess the changes of the patient′s neurological function.Results Preoperative DTI showed 8 cases of typeⅠtumors,all of which could be totally resected;postoperative MRI showed complete resection in all those 8 cases.DTI showed 3 cases of typeⅡtumors,all of which could be completely resected;postoperative MRI showed complete resection in 1 case and near-total resection in 2 cases.None of the above 11 patients had any neurological damage related to surgery.Preoperative DTI showed 4 cases of typeⅢtumors,none of which could be completely resected;postoperative MRI showed near-total resection in 3 cases and subtotal resection in 1 case,of which 2 patients had neurological damage related to surgery.Fifteen patients were followed up for 12.5±1.5 months post operation.At the end of the latest follow-up,10 patients were graded as gradeⅠandⅡand 5 patients as gradeⅢandⅣbased on the McCormick system.Conclusion The preoperative DTI evaluation results of patients with cervical spinal intramedullary tumors are in good agreement with the actual degree of resection.

关 键 词：脊髓肿瘤 弥散张量成像 神经外科手术 治疗结果 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.42[医药卫生—诊断学]