中山大学附属第一医院放射科 林尔坚等
2008ECR演讲论文

目的：探讨3.0T高场磁共振DTI与FMRI联合应用在SM1区脑肿瘤的检查方法，并通过术前术后的比较评价在脑肿瘤患者外科手术前后的应用价值。材料和方法：选取符合要求的脑瘤病人16名，采用SiememsTrio型3.0TMR仪和SiemensLeonardo工作站进行扫描以及数据后处理，术前一周和术后约40天用同样的方法行常规扫描以及DTI和FMRI扫描，FMRI采用EPI－fid序列，选择6时相双手交替运动的组块模式激活SM1区。DTI采用12方向的EPI－diffusion序列，重建双侧皮质脊髓束并测量FA值。通过术前的检查制定手术计划，术后约40天通过同样的检查评价手术结果和该检查的指导意义。结果：FMRI：1例病人术前术后图象均不理想，3例病人初次扫描未能配合，重复训练后能够完成扫描。其余病人顺利完成扫描。DTI：所有病例手术前后的扫描都能成功重建双侧皮质脊髓束。所有病例的图象资料对手术医师切除肿瘤而保留功能区和投射纤维束有帮助，同时对术后病人康复治疗起到指导作用。除2例病人术后KPS评分降低，其余均升高，其中8例恢复到100分。结论：在3.0TMR上应用DTI结合FMRI扫描可行性高，对于脑瘤患者术前手术计划和术后对手术的评价能起到重要的指导作用。
关键词：功能磁共振，弥散张量纤维束成像，肿瘤，运动皮层

TheperioperativeassessmentofSM1areainpatientswithbraintumorusingDTIandfMRIon3T
Purpose:AnevaluationoftheassessmentofSM1areabraintumorusingDTIandFMRIona3.0TMRIscanner,anditsclinicalapplicationinthepre-andpost-operativeinvestigation.Materialsandmethods:RoutineMRI,DTIandFMRIwereperformedin16patientswithbraintumoraweekbeforethesurgicalprocedureaswellas40daysaftertheoperation.ThescanwasdoneonaSiememsTrio3.0TMRscanneranddatawaspost-proceededonaSiemensLeonardoworkstation.TheSM1areawasactivatedbythepatients’sixphasicalternatemovementsoftheirhands.Asequenceof12directionalEPI-diffusionwasusedtoperformtheDTI.Theimagesofthebilateralcorticospinaltract werereconstructed,withFAvaluemeasured,providingapre-operativeguidanceforsurgeons.Sameimagingwasperformedpost-operatively,assessingtheeffectsoftheoperation,whentheimageswerecomparedwiththoseobtainedpre-operativelytoevaluatetheimagingassessmentitself.Results:PoorFMRIimagingwasobtainedinonepatient.In3casesthePre-operativeimagingwassatisfyingafterthepatientsreceivedextratraining.Theimagingwassuccessfulintherest12patients.Bilateralcorticospinaltract wassuccessfullyreconstructedusingDTIinallcases.Imageshelpedsurgeonsmaximallypreservethefunctionalareasandprojectivefiberswhenexcisingthetumor.Only2patientshadworseKPSscalepost-operatively,therest14patientsimprovedtheirKPSscaleaftertumorswereremoved,inwhich8patientsrestored100ontheKPSscale.Conclusion:AssessmentoftheSM1areawithDTIandFMRIusinga3.0MRIscanner,isafeasibleimagingmodalityandmightbeahelpfulguidanceforsurgicalplanningaswellaspost-operativeevaluationinpatientswithbraintumors.
Keyword：functionalMRI,DTI，tumor,motorcortex