联合应用血氧水平依赖功能磁共振成像与扩散张量成像技术在脑肿瘤外科手术中的应用价值

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【摘要】目的探讨联合应用血氧水平依赖功能磁共振成像（BOLD-fMRI）与扩散张量成像（DTI）技术在脑肿瘤外科手术中的应用价值。方法给58例脑肿瘤患者术前进行BOLD-fMRI及DTI检查。以手术诊断结果为参照，比较BOLD-fMRI检查、DTI检查及BOLD-fMRI联合DTI检查对脑肿瘤患者功能区激活、皮质脊髓束受累的诊断结果；分析其在功能区激活、皮质脊髓束受累诊断与手术诊断结果之间的一致性，以及肿瘤与功能区皮质脊髓束的关系，确定手术入路和切除范围。结果参照手术诊断结果，BOLD-fMRI联合DTI检查对运动功能区激活、皮质脊髓束受累的诊断灵敏度、准确率、阴性预测值均高于BOLD-fMRI检查及DTI检查（P＜0.05~0.005），而特异度、阳性预测值之间的差异无统计学意义（均P＞0.05）。BOLD-fMRI联合DTI检查结果与手术诊断结果一致性为高度。本组患者中，肿瘤全部切除者34例，大部分切除23例，1例患者因术中病灶侵及骨质、上矢状窦致破裂出血停止手术。结论联合应用BOLD-fMRI和DTI检查可灵敏、准确反映脑肿瘤患者功能区激活、皮质脊髓束受累情况，可为脑肿瘤切除术前功能区定位、手术入路选择、术中神经功能保护、肿瘤切除范围等提供指导，值得在临床推广应用。

Abstract: Objective To explore the application value of combining blood oxygen level dependent-functional MRI(BOLD-fMRI) and diffusion tensor imaging(DTI) in brain tumor surgery. Methods BOLD-fMRI and DTI were performed in 58 patients with brain tumors before operation. The diagnostic results of BOLD-fMRI, DTI and BOLD-fMRI combined with DTI in the activation of functional areas and involvement of corticospinal tract in patients with brain tumors were compared; The consistency between the diagnosis of functional area activation, corticospinal tract involvement and surgical diagnosis, as well as the relationship between tumor and functional area corticospinal tract were analyzed to determine the surgical approach and resection scope. Results Referring to the results of surgical diagnosis, the sensitivity, accuracy and negative predictive value of BOLD-fMRI combined with DTI in the diagnosis of motor functional area activation and corticospinal tract involvement were higher than those of BOLD-fMRI and DTI(P<0.05~0.005), but there was no significant difference in specificity and positive predictive value(all P>0.05). The consistency between BOLD-fMRI combined with DTI and surgical diagnosis was high. Among the patients in this group, 34 cases were completely resected and 23 cases were mostly resected. One patient stopped the operation due to intraoperative focus invasion of bone and rupture and bleeding of superior sagittal sinus. Conclusions The combined application of BOLD-fMRI and DTI can sensitively and accurately reflect the activation of functional area and the involvement of corticospinal tract in patients with brain tumors. It can provide guidance for the localization of functional area before brain tumor resection, the selection of surgical approach, the protection of intraoperative nerve function and the scope of tumor resection. It is worthy of clinical application.