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目的探讨弥散张量成像(DTI)对提高丘脑肿瘤的全切率和降低其致残率的临床意义。方法 2009～2010年收治的18例丘脑肿瘤患者作为DTI组,术前在MRI平扫加增强的基础行DTI检查,并结合纤维束示踪技术,重建锥体束,根据肿瘤与锥体束的三维空间关系设计手术入路。2007～2009年收治的25例未行DTI检查的丘脑肿瘤患者作为对照组。两组均在神经导航下显微手术切除肿瘤,比较两组患者肿瘤全切率及术后致残率的差异。结果 DTI组肿瘤全切除12例(66.7%,12/18),部分切除4例,活检2例;术后神经功能改善10例(55.5%,10/18),无明显变化6例,恶化2例。对照组肿瘤全切除8例(32.0%,8/25),部分切除10,活检7例;术后神经功能改善7例(28.0%,7/25),无明显变化6例,恶化10,死亡2例。DTI组肿瘤全切率及术后神经功能改善率均明显高于对照组(P<0.05)。结论 DTI有助于提高丘脑肿瘤在导航下手术全切率,并有可能降低其术后致残率。
Objective To investigate the clinical significance of diffusion tensor imaging (DTI) in improving the rate of complete resection and reducing the morbidity of thalamic tumors. Methods 18 patients with thalamic brain tumor who were treated in 2009 ~ 2010 were selected as the DTI group. The patients underwent DTI examination with MRI scan and enhanced MRI before operation. Combined with fiber tracing technique, the pyramidal tract was reconstructed. According to the tumor and pyramidal tract Three-dimensional relationship between the design of surgical approach. Twenty-five patients with thalamic brain tumor without DTI from 2007 to 2009 were selected as the control group. Both groups underwent microsurgical resection of tumors under neuronavigation. The differences of tumor resection rate and postoperative morbidity between the two groups were compared. Results In the DTI group, 12 cases (66.7%, 12/18) had complete resection of the tumor, partial resection in 4 cases and biopsy in 2 cases. The postoperative neurological function improved in 10 cases (55.5%, 10/18), with no significant change in 6 cases and deterioration in 2 example. Eight cases (32.0%, 8/25) were resected in the control group, partial resection was performed in 10 cases and biopsy was performed in 7 cases. There were 7 cases (28.0%, 7/25) in the improvement of neurological function, 6 cases in which there was no obvious change, 10 cases died 2 cases. The rate of tumor resection and postoperative neurological improvement in DTI group were significantly higher than those in control group (P <0.05). Conclusions DTI can help improve the total sag rate of thalamic brain tumor under navigation and possibly reduce the postoperative morbidity.