弥散张量成像在垂体腺瘤患者手术后视觉通路恢复中的应用价值研究  

Study on application value of diffusion tensor imaging on postoperative visual pathway recovery in patients after surgery for pituitary adenoma

作　　者：张良嘉 周辉[2] ZHANG Liang-jia;ZHOU Hui(Jinzhou Medical University Lianyungang First People's Hospital Graduate Training Base,Lianyungang 222002,China)

机构地区：[1]锦州医科大学连云港市第一人民医院研究生培养基地,222002 [2]江苏省连云港市第一人民医院

出　　处：《中国实用医药》2024年第12期38-42,共5页China Practical Medicine

基　　金：江苏省“333工程”培养资金资助项目(项目编号:lyg2017063)。

摘　　要：目的 通过检测垂体腺瘤手术患者术前术后视路弥散张量成像(DTI)指标的变化,分析其特点及影响因素。并采用DTI参数定量分析视觉功能结果与微观结构损伤严重程度的关系,以此探究垂体腺瘤患者术后视力恢复的情况。方法 选取诊断为垂体腺瘤并接受手术治疗的患者22例。收集患者基础资料,术前、术后第一次检查、术后第二次检查三个时期的DTI检查和视力检查资料。比较患者不同时期的各向异性分数(FA)值、弥散系数(ADC)值,分析患者视力恢复情况与年龄、性别的相关性;术前左右两眼FA平均值与视觉功能相关性。结果 患者术后第一次检查FA、ADC相比于术前,具有明显差异(P<0.05),左眼、右眼术前配对FA值分别提高0.09、0.08,左眼、右眼术前配对ADC值分别降低0.25×10^(-10)m^(2)/s、0.39×10^(-10)m^(2)/s。患者术前FA、ADC值相比于术后第二次检查,具有明显差异(P<0.05),左眼、右眼术前配对FA值分别提高0.13、0.11,左眼、右眼术前配对ADC值分别降低0.49×10^(-10)m^(2)/s、0.51×10^(-10)m^(2)/s。患者术后第一次检查FA、ADC值相比于术后第二次检查,具有明显差异(P<0.05),左眼、右眼术前配对FA值分别提高0.04、0.03,左眼、右眼术前配对ADC值分别降低0.24×10^(-10)m^(2)/s、0.12×10^(-10)m^(2)/s。以上结果显示随着患者术后视力视野的恢复,FA值明显增加,ADC值逐步减低。以右眼为例,相关性分析显示,患者年龄、性别与患者术后视觉通路恢复情况无相关性(P>0.05)。对于患者术前的视觉功能,其中视觉功能1级有0例,2级有16例,3级有5例,4级有1例。持续检查患者术后各个时期的视觉功能评分,所有患者视力评分呈降低趋势,视觉功能处于持续好转的过程中。术后第二次检查时,视觉功能1级有14例,2级有7例,3级有1例,4级0例。对患者双眼进行视觉功能评分,术前左右两眼FA值平均值和术前视力评分之间的相关系数Objective To analyze the characteristics and influencing factors of changes in visual pathway diffusion tensor imaging(DTI)indicators in patients undergoing pituitary adenoma surgery before and after surgery,and quantitatively analyze the relationship between visual function results and the severity of microstructural damage using DTI parameters to explore the postoperative visual recovery of patients with pituitary adenoma.Methods 22 patients who were diagnosed with pituitary adenoma and underwent surgical treatment were selected.The basic data,DTI examination and visual acuity examination data of patients were collected preoperatively,at first postoperative examination and the second postoperative examination.The anisotropy fraction(FA)values and apparent diffusion coefficient(ADC)values of the patients in different periods were compared.The correlation of binocular visual acuity recovery with their age and gender,as well as the mean value of preoperative FA in the left and right eyes with visual function were analyzed.Results There were significant differences in FA and ADC at the first postoperative examination compared with those preoperatively(P<0.05),with the preoperative paired FA values in the left eye and the right eye increasing by 0.09 and 0.08,respectively,while the preoperative paired ADC values in the left eye and the right eye decreasing by 0.25×10^(-10) m^(2)/s and 0.39×10^(-10) m^(2)/s.The preoperative FA and ADC values were significantly different compared to the second postoperative examination(P<0.05),with the preoperative paired FA values in the left and right eyes increasing by 0.13 and 0.11,respectively,and the preoperative paired ADC values in the left and right eyes decreasing by 0.49×10^(-10) m2/s and 0.51×10^(-10) m^(2)/s,respectively.Compared with the second postoperative examination,the FA and ADC values were significantly different at the first postoperative examination(P<0.05),with the preoperative paired FA values in the left and right eyes increasing by 0.04 and 0.03,respecti

关 键 词：垂体腺瘤 弥散张量成像 视觉通路 预后 

分 类 号：R445.2[医药卫生—影像医学与核医学] R736.4[医药卫生—诊断学]