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目的探讨弥散张量成像(DTI)技术辅助高级别脑胶质瘤手术的临床效果。方法将该院2006年5月—2015年10月收治的93例高级别脑胶质瘤患者按诊治方法不同分为DTI组(41例)和对照组(52例)。DTI组患者术前行DTI检查,根据DTI技术显示的影像结果手术切口选择避开传导束的脑沟进入。对照组患者术前常规行MRI检查,手术切口选择距离肿瘤较近的脑沟进入。观察行DTI检查患者不同病灶部位的平均弥散系数(MD)、部分各向异性指数(FA)。比较二组患者肿瘤切除率及术后新发功能损害情况。结果 DTI检查结果发现,与正常白质区比较,肿瘤病灶区、瘤周水肿区MD值明显增高,FA值均明显降低(P<0.05);肿瘤病灶区与瘤周水肿区FA值比较差异有统计学意义(P<0.05),而MD值比较差异无统计学意义(P>0.05)。二组均无手术死亡患者。DTI组患者全切除率为90.2%(37/41)。对照组为84.6%(44/52),二组比较差异无统计学意义(P>0.05)。DTI组患者术后未见新发功能损害表现,对照组患者新发功能损害发生率为23.1%(12/52),二组比较差异有统计学意义(P<0.05)。结论 DTI技术能明确界定高级别胶质瘤病灶区、瘤周水肿区及正常白质区,并能明确显示脑胶质瘤与脑白质纤维束的关系,可辅助选择适宜的手术入路及最大限度地切除肿瘤的同时避免新的神经功能损害,值得临床推广。
Objective To investigate the clinical effect of diffusion tensor imaging (DTI) in the treatment of high-grade glioma. Methods 93 cases of high grade gliomas admitted to our hospital from May 2006 to October 2015 were divided into DTI group (41 cases) and control group (52 cases) according to the diagnosis and treatment methods. Patients in the DTI group underwent DTI examinations before surgery. According to the imaging results displayed by the DTI technique, the surgical incision was selected to avoid the sulcus of the conduction beam. Patients in the control group underwent preoperative routine MRI examinations, and surgical incisions were selected to enter the sulcus near the tumor. Observe the DTI examination in patients with different lesion site of the average diffusion coefficient (MD), part of the anisotropy index (FA). The tumor resection rate and postoperative new dysfunction were compared between the two groups. Results Compared with normal white matter, MD value of tumor area and peritumoral edema area were significantly increased (P <0.05), and FA value of tumor area and peritumoral edema area were statistically different (P <0.05), while there was no significant difference between MD values (P> 0.05). There was no operative death in both groups. The total resection rate in DTI group was 90.2% (37/41). The control group was 84.6% (44/52). There was no significant difference between the two groups (P> 0.05). There was no new dysfunction after operation in the DTI group. The incidence of new dysfunction in the control group was 23.1% (12/52). The difference between the two groups was statistically significant (P <0.05). Conclusion The DTI technique can clearly define the high-grade glioma lesion, peritumoral edema and normal white matter, and can clearly show the relationship between glioma and white matter fiber bundles, which can help to choose the appropriate surgical approach and the maximum To remove the tumor while avoiding new neurological damage, it is worth clinical promotion.