摘要目的 探讨弥散张量成像(DTI)在脑干胶质瘤手术治疗中的应用价值.方法 回顾性纳入首都医科大学附属北京天坛医院神经外科2014年1月至2018年12月行手术治疗的57例脑干胶质瘤患者.所有患者均在术前行DTI检查,并在神经导航和神经电生理监测下行肿瘤切除术.收集患者术前的一般资料、MRI和DTI资料,测量皮质脊髓束(CST,双侧共114条)评分、肿瘤-CST的距离(TCD)、手术前后肌力及Karnofsky功能状态评分(KPS)等.采用Kruskal-Wallis H检验比较各CST评分分组的术后肌力和KPS的差异;采用Spearman相关性分析方法分析CST评分及TCD与术后肌力和术后KPS的相关关系;采用多元线性回归分析探究CST评分及TCD对术后肌力和术后KPS的影响.结果 57例患者中,有51例患者至少一侧CST发生改变,其中最常见的类型为推挤(30/114,26.3％)和破坏(30/114,26.3％).其中21例(36.8％)患者的手术入路在评估DTI结果后进行了调整.不同CST评分分组的术后肌力分布与术后KPS分布差异均有统计学意义(χ2=16.011,χ2=9.576;均P<0.05);CST评分与术后肌力和术后KPS均呈负相关(r=-0.362,r=-0.354;均P<0.05);而TCD与术后肌力和术后KPS均呈正相关(r=0.305,r=0.339;均P<0.05).多元线性回归分析显示,CST评分是术后肌力的独立影响因素(t=-2.438,P=0.016),但CST评分不是术后KPS的独立影响因素(t=-0.523,P=0.603).结论 DTI在脑干胶质瘤手术治疗中具有很好的应用价值,其能够帮助优化手术策略,并有助于预判患者术后的肌力情况.

abstractsObjective To explore the role of diffusion tensor imaging ( DTI) in brainstem glioma surgery. Methods A retrospective analysis was performed on 57 patients with brainstem gliomas who had undertaken surgery from January 2014 to December 2018 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. All patients underwent preoperative DTI and tumor resection with the assistance of neuronavigation and electrophysiological monitoring. Radiological and clinical data were collected, including conventional MRI and DTI, corticospinal tract ( CST ) score, tumor-to-CST distance ( TCD) , muscle strength and Karnofsky performance status ( KPS) before and after surgery. Kruskal-Wallis H test was used to evaluate postoperative motor deficit and KPS of patients with different CST scores. Spearman's correlation was performed to assess the relationship of both CST score and TCD with postoperative motor deficits and KPS, respectively. Multiple linear regression was used to investigate the influence of CST score and TCD on postoperative muscle strength and KPS. Results Among the 57 patients, 51 patients had at least one CST compromised. The most common changes of the CST were deviation (30/114, 26. 3％) and deformation (30/114, 26. 3％). The surgical approaches were adjusted after evaluation of the DTI results in 21 (36. 8％) cases. Postoperative muscle strength and KPS were significantly different between different CST score groups (χ2 =16. 011; χ2 =9. 576, all P <0. 05). Preoperative CST scores were negatively correlated with postoperative muscle strength and KPS (r= -0. 362;r= -0. 354, both P<0. 05) whereas TCD had positive correlation with both postoperative muscle strength and KPS ( r=0. 305, r=0. 339, both P<0. 05). CST score could independently influence postoperative muscle strength ( t = -2. 438, P =0. 016). However, CST score could not independently influence postoperative KPS (t= -0. 523, P=0. 603). Conclusion DTI plays an important role in surgical management of brainstem gliomas and could help optimize the surgical strategy and predict postoperative motor deficits.