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目的探讨磁共振扩散张量成像(DTI)技术显示手术前后不同级别脑肿瘤与邻近白质纤维束关系的变化情况及预后。方法对30例经病理证实的脑肿瘤患者,于术前3天、术后1个月行常规MRI及DTI扫描。利用各向异性分数(FA)图测量肿瘤邻近白质纤维束在手术前后及健侧相同位置纤维束的表观扩散系数(ADC)及FA。重组肿瘤邻近白质的纤维束示踪(DTT)图,对比手术前后白质纤维束的位置、形态及完整性并判断患者预后。结果低级别脑肿瘤对邻近白质纤维束的影响以推移、挤压为主,与健侧纤维束比较FA值升高、ADC值减低(P<0.05),术后纤维束形态、位置逐渐恢复正常,FA值及ADC值趋同于健侧,大部分患者的神经系统功能明显改善;高级别脑肿瘤对邻近白质纤维束普遍存在浸润、破坏,术前纤维束的FA值减低,ADC值明显增高(P<0.01),术后虽将肿瘤大部切除,邻近纤维束的FA值及ADC值仍无明显改善,中断、破坏的纤维束亦无恢复,患者的预后明显较低级别组差(P<0.05)。结论 DTI技术可在活体清晰、无创地显示肿瘤与邻近白质纤维束的关系,对不同级别肿瘤患者的预后判断具有参考价值。
Objective To investigate the changes and prognosis of magnetic resonance diffusion tensor imaging (DTI) technique before and after different levels of brain tumors and adjacent white matter fiber bundles. Methods Thirty patients with pathologically confirmed brain tumor underwent routine MRI and DTI scanning three days before surgery and one month after surgery. The apparent diffusion coefficient (ADC) and FA of fiber bundles in the adjacent white matter fiber bundles of the tumor before and after operation and on the healthy side were measured by using the anisotropy fraction (FA) chart. The DTT images of adjacent white matter in the reconstructed tumor were compared with the location, shape and integrity of the white matter fiber bundle before and after surgery and the prognosis was evaluated. Results Low-grade brain tumor affected the adjacent white matter fiber bundles by pushing and squeezing. Compared with the contralateral fiber bundles, the FA value increased and the ADC value decreased (P <0.05). The shape and position of the fiber bundles returned to normal , FA values and ADC values converged to the contralateral side, and the function of most patients was significantly improved. The high-grade brain tumors generally infiltrated and damaged adjacent white matter fiber bundles, the FA value of the preoperative fiber bundles decreased, and the ADC value was significantly increased P <0.01). Although most of the tumors were resected, the FA value and ADC value of the adjacent fiber bundles did not improve obviously, and the interrupted and damaged fiber bundles did not recover. The prognosis of the patients was significantly lower than that of the lower grade group (P < 0.05). Conclusion The DTI technique can clearly display the relationship between tumor and adjacent white matter fiber bundles in vivo and has reference value for the prognosis of patients with different grades of cancer.