CAJ | 학술논문

目的探讨MR DTI在评价胶质瘤病理等级与毗邻纤维束状态之间相关性的价值.方法选择24例经手术及组织病理学证实的胶质瘤患者,术前行常规MRI、DTI.在各向异性分数(FA)图上,ROI设定在瘤周纤维束FA值最低点(Faa)及对侧半球对称区域(Fac),测量出Faa及Fac值,在相同层面ADC图的相同位置,测量出ADC值最低点(ADCa)及对侧半球对标区域ADC(ADCc)值,计算出相对FA值(rFA)和相对ADC值(rADC).利用纤维束追踪技术重组出肿瘤周围纤维束三维图,根据纤维束三维图对纤维束的状态(推移、浸润或者破坏)进行评价.rFA、rADC及瘤周纤维束的状态与胶质瘤的病理级别之间的关系进行独立样本t检验及趋势X2检验.结果24例胶质瘤患者,其中低级别胶质瘤11例,高级别胶质瘤13例.低级别胶质瘤的rFA值为0.65±0.19, rADC值为1.43±0.50,重组的痛周纤维束追踪图主要呈被推移或者浸润;高级别胶质瘤的rFA值为1.51±0.39,rADC值为1.70±0.27,重组的瘤周纤维束追踪图主要旱被浸润或者被破坏.rFA值在高级、低级别胶质瘤之间差异有统计学意义(t=8.504,P=0.000),而rADC值差异无统计学意义(t=-1.435,P=0.165);纤维束的状态在高级、低级别胶质瘤之间差异亦有统计学意义(X2=5.882,P=0.015).结论胶质瘤的病理等级影响瘤周纤维束的状态,rFA可作为一个参考指标,有助于鉴别胶质瘤的恶性程度;DTI可清楚显示肿瘤与周围白质纤维的解剖位置关系,并能显示瘤周纤维不的病理状态,指导治疗方案的制定.
목적 탐토MR DTI재평개효질류병리등급여비린섬유속상태지간상관성적개치.방법 선택24례경수술급조직병이학증실적효질류환자,술전행상규MRI、DTI.재각향이성분수(FA)도상,ROI설정재류주섬유속FA치최저점(Faa)급대측반구대칭구역(Fac),측량출Faa급Fac치,재상동층면ADC도적상동위치,측량출ADC치최저점(ADCa)급대측반구대표구역ADC(ADCc)치,계산출상대FA치(rFA)화상대ADC치(rADC).이용섬유속추종기술중조출종류주위섬유속삼유도,근거섬유속삼유도대섬유속적상태(추이、침윤혹자파배)진행평개.rFA、rADC급류주섬유속적상태여효질류적병리급별지간적관계진행독립양본t검험급추세X2검험.결과24례효질류환자,기중저급별효질류11례,고급별효질류13례.저급별효질류적rFA치위0.65±0.19, rADC치위1.43±0.50,중조적통주섬유속추종도주요정피추이혹자침윤;고급별효질류적rFA치위1.51±0.39,rADC치위1.70±0.27,중조적류주섬유속추종도주요한피침윤혹자피파배.rFA치재고급、저급별효질류지간차이유통계학의의(t=8.504,P=0.000),이rADC치차이무통계학의의(t=-1.435,P=0.165);섬유속적상태재고급、저급별효질류지간차이역유통계학의의(X2=5.882,P=0.015).결론효질류적병리등급영향류주섬유속적상태,rFA가작위일개삼고지표,유조우감별효질류적악성정도;DTI가청초현시종류여주위백질섬유적해부위치관계,병능현시류주섬유불적병리상태,지도치료방안적제정.
Objective To investigate the relationship between the grade of gliomas and the status of adjacent fiber tract with DTL Methods MRI and DTI were performed in 24 patients with histologically confirmed brain gliomas.Regions of interest were placed in the white matter adjacent to the tumor with the lowest FA(Faa) and in the white matter of the contralateral hemisphere(Fac).The values of Faa and Fac were measured.In the regions of the same slice, the values of ADCa and ADCc were measured. Relative fractional anisotropy ratios (rFA) and relative apparent diffusion coefficient ratios (rADC) were also calculated.The status of fiber tracts adjacent to the gliomas were characterized as displacement, infiltration or disruption.Fiber tracking using the Fiber Assignment by Continuous Tracking (FACT) method was performed to investigate the integrity of white matter tracts in the surrounding border zone of the gliomas.The correlation of rFA, rADC, the state of adjacent fiber tracts, and the grade of gliomas were analyzed statistically by using independent sample t test and tendency X2 test.Results Eleven of the 24 tumors were demonstrated as low grade gliomas (WHO grade Ⅰ-Ⅱ) and 13 were high grade giiomas (WHO grade Ⅲ-Ⅳ).The average rFA and rADC of the low grade gliomas were 0.65±0.19 and 1.43 ± 0.50 respectively.Most of fiber tracts in the periphery of the low grade gliomas were displaced or infiltrated.The average rFA and rADC of the high grade gliomas were 1.51 ± 0.39 and 1.70 ±0.27 respectively.Most of fiber tracts in the periphery of the high grade gliomas were infiltrated or disrupted.Significant difference was found for rFA (t =8.504,P =0.000) and but not for rADC(t = - 1.435 ,P =0.165) between low grade and high grade gliomas.Significant difference existed between the state of fiber tracts adjacent to ghomas and low and high-grade(X2 =5.882 ,P =0.015).Conclusions The malignancy of gliomas influences the state of fiber tracts in the vicinity of tumors, rFA can serve as a reference for distinguishment of high-grade and low-grade gliomas.DTI can depict the localization of gliomas and the adjacent fiber tracts.The state of fiber tracts can also be identified by DTI.It is helpful for the therapeutic plan of the tumors.