多模态MRI结合超声在脑胶质瘤术中的应用

发布时间：2018-11-25 11:43

【摘要】：目的:分析多模态MRI结合超声辅助手术的脑胶质瘤病人的临床资料,探讨多模态MRI中MRS在判断肿瘤级别、DTI在设计手术入路及避免脑皮质纤维束损伤、超声提高肿瘤切除程度等方面的应用价值。方法:收集2015年1月至2016年12月收集2015年1月至2016年12月我院神经外科术后病理明确为胶质瘤病人资料87例,使用多模态MRI结合超声显微手术切除肿瘤病人资料41例,另外46例病人根据常规MRI显微手术,评估两组病人肿瘤切除程度及预后相关评分差别。结果:(1)高、低级别脑胶质瘤瘤体Lac峰比较:x2值=2.303,P0.05高、低级别脑胶质瘤瘤体Lip峰比较:x2值=4.830,P0.05。(2)检验示纤维束的形态差异Z=17.688,P0.05。(3)使用显微手术肿瘤全切率54.35%,使用超声辅助显微手术肿瘤全切率75.61%,x2值=4.272,P0.05。(4)预后评估:使用常规MRI显微手术的术后KPS评分=73.89±10.83,使用多模态MRI辅助显微手术的术后KPS评分=84.75±10.83,t值=2.993,P0.05。结论:多模态MRI技术中波谱分析技术有利于判断肿瘤的良恶性程度,弥散张量成像技术可提示肿瘤与重要纤维束的毗邻关系,通过皮质纤维束形态改变判断肿瘤级别、设计手术路径,结合超声可准确定位、明确脑胶质瘤界限,在保护神经功能同时最大限度切除肿瘤,显著提高肿瘤全切率,有效避免病人术后出现永久性功能损伤,改善预后。
[Abstract]:Objective: to analyze the clinical data of glioma patients undergoing multimodal MRI combined with ultrasound assisted surgery, and to explore the role of MRS in judging tumor grade in multimodal MRI and the design of surgical approach for DTI in order to avoid cortical fiber bundle injury. Application value of ultrasound in tumor resection. Methods: from January 2015 to December 2016, 87 patients with glioma were collected from January 2015 to December 2016, and 41 patients were resected by multi-mode MRI combined with ultrasound microsurgery. According to conventional MRI microsurgery, 46 patients were evaluated for tumor resection degree and prognostic scores. Results: (1) comparison of Lac peak in high and low grade gliomas: x2 = 2.303%, Lip peak in low grade gliomas: x2 = 4.830 (P0.05). (2) the morphological differences of fibrous bundles were observed. P0.05. (3) Total removal rate of tumor was 54.35 by microsurgery, total removal rate of tumor by ultrasound assisted microsurgery was 75.61x2 = 4.272, P0.05. (4) prognosis: the postoperative KPS score of conventional MRI microsurgery was 73.89 卤10.83, and the postoperative KPS score of multimodal MRI assisted microsurgery was 84.75 卤10.83 t = 2.993U P0.05. Conclusion: the spectral analysis of multimodal MRI is helpful to judge the degree of benign and malignant tumor. Diffusion Zhang Liang imaging technique can indicate the adjacent relationship between tumor and important fibrous bundles, and judge the grade of tumor by cortical fiber bundle morphological change. The operative path was designed, combined with ultrasound to locate the brain glioma accurately, to define the boundary of glioma, to remove the tumor at the same time as protecting the nerve function, to increase the total resection rate of tumor, to avoid the permanent functional injury and to improve the prognosis after operation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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