目的 探讨MR DTI评价幕上胶质瘤对锥体束侵袭性的价值.方法 对23例经手术病理证实的胶质瘤患者进行DTI分析.按照肿瘤恶性程度分为高(n=16)、低(n=7)级别胶质瘤；按照临床是否有肢体感觉和(或)运动异常分为有症状(n=11)和无症状(n=12).分析测定患侧和对侧锥体束ADC值和FA值,并进行锥体束三维成像和统计学检验.结果 高级别胶质瘤患侧内囊后肢层面锥体束FA值显著低于对侧(P＜0.05).高低级别胶质瘤各层面锥体束ADC值与对侧差异均无统计学意义.有肢体感觉和(或)运动异常者的患侧内囊后肢层面锥体束ADC值高于对侧(P＜0.01),患侧锥体束内囊后肢层面及大脑脚层面锥体束FA值低于对侧(P＜0.05),而脑桥层面FA值与对侧比较差异均无统计学意义(P＞0.05).有肢体感觉和(或)运动异常者的患侧锥体束重建可见锥体束浸润、破坏.结论 应用DTI能够较准确地判定幕上胶质瘤对锥体束的侵袭情况.%Objective To observe the value of MR DTI in assessing the invasion of supratentorial gliomas to pyramidal tract. Methods Twenty-three patients of brain supratentorial glioma proved with pathology underwent MR DTI. Giomas were divided into low (n = 7) and high grade groups (n=16) according to tumor malignancy, and were divided into symptomatic group (n=ll) and non-symptomatic group (n= 12) according to the limb symptoms. ADC and FA of pyramidal tract were recorded, and the pyramidal tracts were reconstructed and analyzed statistically. Results FA values of pyramidal tracts of tumor side in the internal capsule area were significantly lower than those in contralateral part in high grade gliomas (P<0. 05). There was no difference of ADC among all three locations in both low and high grade gliomas. ADC of the pyramidal tract in internal capsule in the tumor side in the symptomatic group was higher than that in contralateral part (P<0. 01). FA values of pyramidal tracts of tumor side in the internal capsule area and cerebral peduncle area were lower than those in contralateral part in the symptomatic group (P<0. 05), but there was no difference of pyramidal tract in the pone slices (P>0. 05). Infiltration and destroy of the pyramidal tracts could be seen in the tumor side in symptomatic group in the reconstruction images. Conclusion MR DTI can display the infiltration of pyramidal tracts caused by supratentorial gliomas in details.
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