弥散张量成像对胶质瘤手术切除程度的早期评估价值研究

摘要

目的：研究弥散张量成像对胶质瘤手术切除程度及预后的早期评估。方法：选取在山西医科大学第一临床医学院神经外科住院手术治疗，且在术中影像学基础上达到尽全切，剔除术后3个月肿瘤进展病例后符合标准的20例患者，年龄42~79岁，平均（57.95±10.82）岁，其中男11例，女9例。采用直接测量法及弥散张量成像（DTI）辅助测量法对20例胶质瘤患者行术前、术后72 h及术后3个月的扫描，在术后MRT1加权像上不同层面分别手工描记残余肿瘤边界，获取术后72 h及术后3个月残余肿瘤体积进行比较分析。结果：经直接测量法获取术后72 h残余肿瘤体积明显大于DTI辅助测量法获取的术后72 h残余肿瘤，差异有统计学意义（t=4.924，P<0.001），直接测量法获取术后3个月残余肿瘤体积明显大于DTI辅助测量法获取的术后3个月的残余肿瘤，差异有统计学意义（t=2.311，P=0.026）。经直接测量法获取的术后72 h残余肿瘤体积明显大于术后3个月的残余肿瘤，差异有统计学意义（t=10.013，P<0.001），经DTI辅助测量法获取的术后72 h残余肿瘤体积明显大于术后3个月的残余肿瘤，差异有统计学意义（t=7.389，P<0.001）。结论：将DTI技术用于评估胶质瘤手术切除程度，能够保护患者的神经系统功能，提高手术疗效评估的准确性。%Objective:To evaluate the utility of diffusion tensor imaging(DTI)in early assessment of extent of surgical resection and prognosis of gliomas surgical.Method:Selected the patients who were given operation treatment in neurosurgical department in first Clinical College of Shanxi Medical University,achieved the full cut based on the best imaging technique in operation and excluded tumor progression cases after 3 months,a total of 20 patients up to the standard.Patients were 42 to 79 years old,the average age was(57.95±10.82)years old,including 11 males and 9 females.The scanning of 20 glioma patients with preoperative and postoperative 72 hours and 3 months were performed by direct measurement and diffusion tensor imaging(DTI)auxiliary measurements.Tracings tumor boundaries with hand on different levels of postoperative MRT1 weighted images.Residual tumor volume after 72 hours and 3 months were analyzed and compared.Result:The volume of residual tumor after 72 hours by direct measurement was significantly larger than that by DTI acquiring auxiliary measurement,the difference was statistically significant(t=4.924,P<0.001). The volume of residual tumor after 3 months by direct measurement was significantly larger than that by DTI acquiring auxiliary measurement,the difference was statistically significant(t=2.311,P=0.026).The volume of residual tumor after 72 hours by direct measurement was significantly larger than that after 3 months,the difference was statistically significant(t=10.013,P<0.001).The volume of residual tumor after 72 hours by DTI acquiring auxiliary measurement was significantly larger than that after 3 months,the difference was statistically significant(t=7.389,P<0.001). Conclusion:DTI can be used in assessing the extent of surgical resection of gliomas to protect the nervous system function and improve the accuracy of surgery assessment.