脑弥散张量成像与纤维束造影的临床应用

M. Elsheikh, Eman Al Saadawy, M. Reda, M. Khaled
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摘要

弥散张量成像(DTI)和纤维束造影是相对较新的MRI技术,它们为人类大脑白质(WM)连接打开了一个全新的无创窗口。自引入以来,它们迅速发展,并在几乎所有涉及WM的疾病中找到了应用。目的研究DTI和纤维束造影在各种肿瘤性和非肿瘤性脑病变中的临床应用,并证明它们在术前与脑病变相关的WM束定位中的作用。患者和方法一项前瞻性研究对40例到亚历山大大学就诊的WM束相关颅内病变患者进行了为期2年的DTI和纤维束造影。这项研究包括25名男性和15名女性。患者年龄6 ~ 76岁,平均年龄40.7岁。采用定向编码彩色图和三维示踪重建对DTI数据进行定性分析。结果视觉分析显示,多发投影、联合和/或互交WM纤维束受累;最常见的是皮质脊髓束,25例(62.5%)。WM束受累模式为偏离/分叉束31例(64.6%),浸润9例(18.8%),水肿5例(10.4%),中断3例(6.3%)。结论DTI和纤维束造影是一种有价值的无创技术,可提供定性信息,有助于病灶特征的描述,确定WM的完整性,对脑内病变患者的手术计划至关重要。
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Clinical applications of brain diffusion-tensor imaging and fiber tractography
Background Diffusion-tensor imaging (DTI) and fiber tractography are relatively recent MRI techniques that have opened an entirely new noninvasive window on the white matter (WM) connectivity of the human brain. Since their introduction, they have rapidly evolved and found application in essentially every disorder involving the WM. Aim The aim of this work was to study the clinical applications of DTI and fiber tractography in various neoplastic and nonneoplastic brain lesions, as well as to demonstrate their role in preoperative mapping of WM tracts in relation to brain lesions. Patients and methods A prospective study was conducted for 2 years on 40 patients presenting to Alexandria University with variable intracranial lesions related to WM tracts who underwent DTI and fiber tractography. The study included 25 males and 15 females. The age of the patients ranged from 6 to 76 years (mean age, 40.7 years). Qualitative analysis of DTI data was performed using directionally encoded color maps and three-dimensional tractography reconstruction. Results According to visual analysis multiple projection, association and/or commissural WM fiber tracts were involved; the most common was the corticospinal tract in 25 (62.5%) cases. WM tract involvement patterns were deviated/splayed tracts in 31 (64.6%) cases, infiltrated in nine (18.8%) cases, edematous in five (10.4%) cases, and interrupted in three (6.3%) cases. Conclusion DTI and fiber tractography are valuable noninvasive techniques providing qualitative information aiding in lesion characterization, determining WM integrity, and essential in the surgical planning for patients with intrinsic brain lesions.
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