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目的探讨MR扩散张量成像(DTI)多参数值在脑肿瘤中的诊断和鉴别诊断价值;评价扩散张量纤维束成像(DTT)在显示脑肿瘤与周围脑白质纤维束关系中的应用。资料与方法搜集经手术病理证实的星形细胞瘤(低级别、高级别)、脑膜瘤、转移瘤患者资料(低级别星形细胞瘤15例,高级别星形细胞瘤18例,脑膜瘤16例,转移瘤10例)共59例。行常规T1WI、T2WI、增强T1WI及DTI。测量病灶肿瘤实质区、瘤周水肿区、囊变坏死区、水肿邻近正常白质区及对侧正常白质区的平均扩散系数(DCavg)值、部分各向异性分数(FA)值、1-容积比(1-VR)值及相对各向异性(RA)值,分析各测量值在肿瘤的诊断及良恶性鉴别诊断中的作用。利用DTI数据进行DTT重组病变周围脑白质纤维束,观察肿瘤与脑白质纤维束的关系。结果低级别星形细胞瘤、高级别星形细胞瘤、脑膜瘤及转移瘤的肿瘤实体、瘤周水肿区的FA值、1-VR值及RA值差异均具有统计学意义(P<0.05);对侧正常白质区DCavg值、FA值、1-VR值及RA值差异均具有统计学意义(P<0.05)。FA图、FA彩色编码图、DTT图均能显示脑白质纤维受累情况,而常规MRI难以显示;脑白质纤维束与脑肿瘤的位置关系可分为四型,即推挤型、水肿型、浸润型和破坏型。低级别星形细胞瘤及脑膜瘤良性肿瘤周围的白质纤维束多呈推挤水肿改变,而高级别星形细胞瘤及转移瘤恶性肿瘤周围的白质纤维束多表现为以浸润破坏为主。结论DTI较常规MRI能更确切、直观地显示脑内肿瘤与周围脑白质的关系,结合FA值、1-VR值及RA值能为肿瘤的诊断及鉴别诊断提供更多的依据;DTT可以为临床提供更多的肿瘤及其周围白质纤维束的信息,指导术前计划的制定和术后的评估。
Objective To investigate the value of MR diffusion tensor imaging (DTI) in the diagnosis and differential diagnosis of brain tumors. To evaluate the application of diffusion tensor tractography (DTT) in the relationship between brain tumors and peripheral white matter fiber bundles. Materials and Methods Data of patients with astrocytoma (low grade, high grade), meningiomas and metastases confirmed by surgery and pathology were collected (15 cases of low grade astrocytoma, 18 cases of high grade astrocytoma, Cases, metastases in 10 cases) a total of 59 cases. Routine T1WI, T2WI, enhanced T1WI and DTI. The average DCavg value, partial anisotropy (FA) value, 1-volume ratio of the tumor in the tumor area, peritumoral edema area, cystic necrosis area, normal white matter adjacent to the edema and contralateral normal white matter area were measured. (1-VR) values and relative anisotropy (RA) values were analyzed. The role of each measured value in the diagnosis of the tumor and the differential diagnosis of benign and malignant tumors were analyzed. DTI data were used to investigate the relationship between tumor and white matter fiber bundles. Results The FA, 1-VR and RA values of low grade astrocytoma, high grade astrocytoma, meningioma and metastatic tumor were all significantly different (P <0.05) ; DCavg value, FA value, 1-VR value and RA value of contralateral normal white matter were all statistically significant (P <0.05). FA map, FA color coded map and DTT map can all show the involvement of white matter in the white matter, while conventional MRI is difficult to display. The location of the white matter in the brain is classified into four types: push type, edema type, Type and destruction type. Low-grade astrocytoma and meningioma benign tumor around the white matter fiber bundles tend to push the edema changes, and high-grade astrocytoma and metastatic tumor around the white matter fiber bundles mostly manifested as infiltration and destruction. Conclusion Compared with conventional MRI, DTI can show the relationship between brain tumor and surrounding brain white matter more accurately and intuitively. Combined with FA value, 1-VR value and RA value, DTI can provide more basis for the diagnosis and differential diagnosis of tumor. DTT can be Clinically provide more information about the tumor and the surrounding white matter fiber bundles, and guide the preoperative planning and postoperative evaluation.