DTI应用于伽玛刀治疗脑运动功能区肿瘤的初步研究

发布时间：2018-05-25 14:23

  本文选题：弥散张量成像 + 脑肿瘤　； 参考：《内蒙古医科大学》2017年硕士论文

【摘要】：目的:将DTI应用于伽玛刀治疗脑运动功能区肿瘤的计划制定,以期在最大程度消灭肿瘤的同时,最大程度保护患者的神经功能,提升治疗的安全性,提高患者生存质量。同时探讨DTI在辅助伽玛刀治疗颅内功能区肿瘤中的应用,初步明确DTI应用于伽玛刀治疗的优势。方法:收集2015年1月~2016年6月在我科接受伽玛刀治疗的74例脑运动功能区肿瘤患者作为研究对象,其中DTI组与对照组患者各37例。所有患者均在接受治疗前1周内行常规MRI及增强扫描,DTI组患者在接受治疗前3天内行DTI扫描,得到重建锥体束图像。制定治疗计划时,DTI组将重建的锥体束三维重建图像融入伽玛刀治疗计划系统,根据锥体束走形及其与病灶的位置关系适当调整预期治疗方案,而对照组仍按颅脑正常解剖关系及操作者临床经验制定计划方案。有肢体活动障碍的患者在出院前复查患肢肌力,评估肌力改善情况。两组患者均在接受伽玛刀治疗后3个月左右复查头颅常规及增强MRI,评估肿瘤控制情况,同时根据患者临床症状对其进行KPS及ZEW评分,并评估肌力改善情况。治疗后6个月再次随访,评估患者肌力、KPS及ZEW评分。计算接受伽玛刀治疗后3个月、6个月时两组患者中KPS评分≥70分、ZEW评分≤3分、肌力Ⅲ级的患者百分比及并发症发生率。采用两独立及配对样本的t检验分析计量资料,定性资料的比较采用X~2检验。结果:DTI组患者出院前运动功能缓解率(69%)高于对照组患者(52%),但差异无统计学意义(X~2=1.626,P=0.266)。伽玛刀治疗后3个月两组患者的肿瘤控制率、并发症发生率、患肢肌力及KPS评分均无统计学意义(P=0.430;P=0.495;P=0.498;P=0.457),而ZEW评分差异有统计学意义(X~2=5.638,P=0.035)。伽玛刀治疗后6个月DTI组患者的并发症发生率明显低于对照组(X~2=5.115,P=0.044),DTI组治疗前有肢体活动障碍的患者肌力稳定情况优于对照组(X~2=5.955,P=0.028);DTI组患者KPS评分及ZEW评分均优于对照组(X~2=5.409,P=0.036;X~2=4.893,P=0.048)。结论:将DTI应用于伽玛刀治疗脑运动功能区肿瘤可以较为准确地判断肿瘤与锥体束的关系,实现个体化的方案制定,在保证肿瘤局部控制率的同时最大程度地保护患者的神经功能,降低并发症发生率,提高患者远期生存质量,从而达到“病变消除最大化,功能损伤最小化”的目标。
[Abstract]:Objective: to make a plan for the treatment of tumors in brain motor function area by gamma knife in order to protect the nervous function of the patients, improve the safety of the treatment and improve the quality of life of the patients at the same time of eliminating the tumor to the greatest extent. At the same time, we discussed the application of DTI in the treatment of intracranial functional tumors with gamma knife, and preliminarily confirmed the advantages of DTI in gamma knife therapy. Methods: from January 2015 to June 2016, 74 patients with brain motor function area tumor received gamma knife therapy in our department, including 37 patients in DTI group and 37 patients in control group. All the patients received conventional MRI and enhanced DTI within 3 days before treatment, and the reconstructed pyramidal bundle images were obtained. When the treatment plan was made, the DTI group integrated the reconstructed three-dimensional reconstruction image of the pyramidal tract into the gamma knife therapy planning system, and adjusted the expected treatment plan according to the shape of the pyramidal tract and its relationship with the lesion. In the control group, the plan was made according to the normal anatomical relationship of the brain and the clinical experience of the operator. Patients with limb dyskinesia were reviewed before discharge to assess the improvement of muscle strength. The patients in both groups were reviewed the cranial routine and enhanced MRI about 3 months after gamma knife therapy to evaluate the control of tumor, and to evaluate the improvement of muscle strength according to the clinical symptoms of the patients with KPS and ZEW. The patients were followed up 6 months after treatment to evaluate the KPS and ZEW score. The percentage of patients with KPS 鈮，

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