CAJ | 학술논문

目的探讨MR扩散张量成像(DTI)及扩散张量纤维束成像(DTT)技术对累及脑干肿瘤围手术期的应用价值.方法连续收集经住院手术并病理证实的35例累及脑干肿瘤患者,同时选取与患者性别及年龄层次匹配的35名健康志愿者作为正常对照.对所有患者及正常对照行DTI扫描,利用DTI及DTT技术评估患者皮质脊髓束(CST)及内侧丘系(ML)损伤程度并分级,同时评价患者神经功能障碍等级.采用Spearman相关性分析评价CST及ML损伤分级与肢体运动、感觉功能障碍之间的相关性.结果神经纤维损伤程度分级中,CST正常、移位、水肿或浸润、破坏分别为9、9、1 1、6例,ML分别为8、9、15、3例.运动功能分级中,无缺失、轻度缺失、中度缺失分别为20、11、4例;感觉功能分级中,无缺失、轻度缺失、中度缺失分别为21、6、8例.患者运动功能障碍与CST损伤程度、感觉功能障碍与ML损伤程度均呈正相关(r值分别为0.786、0.686,P值均＜0.01).所有肿瘤与CST及ML的位置关系在图像上均可得到良好显示,制定了对应的手术方案.所有患者术后均未出现新的神经功能障碍.结论 DTI及DTT技术可用于累及脑干肿瘤围手术期评估CST及ML的损伤程度,并能直观显示脑干CST及ML与肿瘤的位置关系,对脑干纤维束的术中保护、术后评估恢复状况有重要的临床意义.
목적 탐토MR확산장량성상(DTI)급확산장량섬유속성상(DTT)기술대루급뇌간종류위수술기적응용개치.방법 련속수집경주원수술병병리증실적35례루급뇌간종류환자,동시선취여환자성별급년령층차필배적35명건강지원자작위정상대조.대소유환자급정상대조행DTI소묘,이용DTI급DTT기술평고환자피질척수속(CST)급내측구계(ML)손상정도병분급,동시평개환자신경공능장애등급.채용Spearman상관성분석평개CST급ML손상분급여지체운동、감각공능장애지간적상관성.결과 신경섬유손상정도분급중,CST정상、이위、수종혹침윤、파배분별위9、9、1 1、6례,ML분별위8、9、15、3례.운동공능분급중,무결실、경도결실、중도결실분별위20、11、4례;감각공능분급중,무결실、경도결실、중도결실분별위21、6、8례.환자운동공능장애여CST손상정도、감각공능장애여ML손상정도균정정상관(r치분별위0.786、0.686,P치균＜0.01).소유종류여CST급ML적위치관계재도상상균가득도량호현시,제정료대응적수술방안.소유환자술후균미출현신적신경공능장애.결론 DTI급DTT기술가용우루급뇌간종류위수술기평고CST급ML적손상정도,병능직관현시뇌간CST급ML여종류적위치관계,대뇌간섬유속적술중보호、술후평고회복상황유중요적림상의의.
Objective To explore the value of diffusion tensor imaging (DTI) and diffusion tensor tracography (DTT) in assessment of Corticospinal tract (CST) and medial lemniscus (ML) in tumors involving brainstem.Methods A total of 35 cases with pathologically confirmed tumors involving brainstem were collected,and 35 volunteers matched with genders and ages were recruited as the normal group.DTI scanning was performed on all the patients and controls.The damage degrees of CST and ML were evaluated and graded by DTT,and the dysfunction degrees were evaluated for the patients.Spearman correlation was used to statistically analyze the relationships of limb movement,sensory dysfunction and CST and ML damage.Results According to the rating results,normal findings,shifting,edema or infiltration and damage of CST was found in 9,9,11,and 6 cases respectively.They were 8,9,15,3 cases for ML.Motor function was normal in 20 cases,slightly defective in 11 cases,and moderate defective in 4 cases.Sensory function was normal in 21 cases,slightly defective in 6 cases,and moderate defective in 8 cases.The patients' dyskinesia and CST damage degree,sensory dysfunction and ML damage degree were positively correlated (r was 0.786 and 0.686 respectively,P ＜ 0.01).The position relationship among tumor and CST and ML could be well displayed on images.None of the patients showed new symptoms of dysneuria after surgery.Conclusions DTI and DTT technology can be used to evaluate CST and ML damage degree in tumors involving brainstem.They can display the position relationship between tumor and the brainstem CST and ML,which is important in protecting the brainstem fiber tract during operation and evaluating the recovery after the operation.