CAJ | 학술논문

目的：探讨磁共振弥散张量成像技术在高级别胶质瘤导航术中的应用价值。方法2009年10月~2013年10月在汕头大学医学院第一附属医院住院治疗的27例高级别胶质瘤患者，术前均行常规的MR和磁共振弥散张量成像(DTI)技术检查，并对患者行显微外科手术治疗，皮层切口根据术前DTI显示的肿瘤与功能传导束的关系，选择避开传导束的脑沟进行。观察患者不同病变部位DTI的平均弥散系数(MD)值、部分各向异性指数(FA)值及肿瘤全切除率及患者的生存时间。结果27例高级别胶质瘤患者肿瘤病灶区、灶周水肿区及正常白质区的MD值分别为(1.260±0.268)×10-9、(1.129±0.143)×10-9、(0.830±0.091)×10-9 mm2/s，与正常白质区的MD值比较，肿瘤病灶区、灶周水肿区均升高，差异均有统计学意义(P<0.05)；27例高级别胶质瘤患者肿瘤病灶区、灶周水肿区及正常白质区的FA值分别为(0.177±0.026)、(0.221±0.034)、(0.401±0.047)，3个不同部位两两比较，差异均有统计学意义(P<0.05)。27例患者全切25例，近全切除2例，全切除率为92.6%(25/27)。术后患者临床症状改善不明显。27例患者中位生存时间为10.0个月。结论 DTI能很好地显示白质纤维的走行，可区分高级别胶质瘤患者肿瘤病灶区、灶周水肿区及正常白质区，为术者提供合理的手术入路，为术中精确的影像导航提供充分的保证，使术者在不损伤脑功能结构的前提下尽可能的切除肿瘤组织，延长患者的生存期。
목적：탐토자공진미산장량성상기술재고급별효질류도항술중적응용개치。방법2009년10월~2013년10월재산두대학의학원제일부속의원주원치료적27례고급별효질류환자，술전균행상규적MR화자공진미산장량성상(DTI)기술검사，병대환자행현미외과수술치료，피층절구근거술전DTI현시적종류여공능전도속적관계，선택피개전도속적뇌구진행。관찰환자불동병변부위DTI적평균미산계수(MD)치、부분각향이성지수(FA)치급종류전절제솔급환자적생존시간。결과27례고급별효질류환자종류병조구、조주수종구급정상백질구적MD치분별위(1.260±0.268)×10-9、(1.129±0.143)×10-9、(0.830±0.091)×10-9 mm2/s，여정상백질구적MD치비교，종류병조구、조주수종구균승고，차이균유통계학의의(P<0.05)；27례고급별효질류환자종류병조구、조주수종구급정상백질구적FA치분별위(0.177±0.026)、(0.221±0.034)、(0.401±0.047)，3개불동부위량량비교，차이균유통계학의의(P<0.05)。27례환자전절25례，근전절제2례，전절제솔위92.6%(25/27)。술후환자림상증상개선불명현。27례환자중위생존시간위10.0개월。결론 DTI능흔호지현시백질섬유적주행，가구분고급별효질류환자종류병조구、조주수종구급정상백질구，위술자제공합리적수술입로，위술중정학적영상도항제공충분적보증，사술자재불손상뇌공능결구적전제하진가능적절제종류조직，연장환자적생존기。
Objective To discuss the magnetic resonance diffusion tensor imaging technology value of the high-grade gliomas navigation intraoperative. Methods From October 2009 to October 2013, in the First Affiliated Hospital to Medical College of Shantou University, 27 patients with high-grade gliomas were given conventional MR and magnetic resonance diffusion tensor imaging (DTI) technical inspection before the surgery, patients were given microsurgery and surgical treatment, according to the relationship between preoperative tumor DTI display and function tracts skin inci-sion was chosen to avoid tracts sulci. Patients were observed the average diffusion coefficient (MD) values of different lesions DTI, fractional anisotropy index (FA) values and tumor resection rate and survival time of patients. Results MD value of 27 patients with high-grade glioma tumor lesions, perifocal edema and normal white matter areas were (1.260±0.268)í10-9, (1.129±0.143)í10-9, (0.830±0.091)í10-9 mm2/s, compared with normal white matter areas, MD value of tu-mor lesions, perifocal edema, the differences were statistically significant (P < 0.05); FA values of 27 patients with high-grade glioma tumor lesions, perifocal edema and normal white matter area were (0.177±0.026), (0.221±0.034), (0.401±0.047), two different parts of the pairwise were compared, the differences were statistically significant differ-ences (P<0.05). Among 27 patients, 25 cases were given total resection, 2 cases were given subtotal resection, the rate of totle resection was 92.6% (25/27). Postoperative improvement in clinical symptoms was not obvious, the median sur-vival time of 27 patients were 10.0 months. Conclusion DTI can be a good indication of white matter fibers traveling, can distinguish patients with high-grade glioma tumor lesions, perifocal edema and normal white matter, provide a rea-sonable surgical approach for the surgeon, provide adequate assurance for precise intraoperative image guidance, so the surgeon should remove the tumor tissue in brain function without structural damage as much as possible, prolong sur-vival time of patients.