本文選題：彌散張量成像 + 腦腫瘤�。� 參考：《內(nèi)蒙古醫(yī)科大學》2017年碩士論文

【摘要】：目的:將DTI應用于伽瑪?shù)吨委熌X運動功能區(qū)腫瘤的計劃制定,以期在最大程度消滅腫瘤的同時,最大程度保護患者的神經(jīng)功能,提升治療的安全性,提高患者生存質(zhì)量。同時探討DTI在輔助伽瑪?shù)吨委燂B內(nèi)功能區(qū)腫瘤中的應用,初步明確DTI應用于伽瑪?shù)吨委煹膬?yōu)勢。方法:收集2015年1月~2016年6月在我科接受伽瑪?shù)吨委煹?4例腦運動功能區(qū)腫瘤患者作為研究對象,其中DTI組與對照組患者各37例。所有患者均在接受治療前1周內(nèi)行常規(guī)MRI及增強掃描,DTI組患者在接受治療前3天內(nèi)行DTI掃描,得到重建錐體束圖像。制定治療計劃時,DTI組將重建的錐體束三維重建圖像融入伽瑪?shù)吨委熡媱澫到y(tǒng),根據(jù)錐體束走形及其與病灶的位置關系適當調(diào)整預期治療方案,而對照組仍按顱腦正常解剖關系及操作者臨床經(jīng)驗制定計劃方案。有肢體活動障礙的患者在出院前復查患肢肌力,評估肌力改善情況。兩組患者均在接受伽瑪?shù)吨委熀?個月左右復查頭顱常規(guī)及增強MRI,評估腫瘤控制情況,同時根據(jù)患者臨床癥狀對其進行KPS及ZEW評分,并評估肌力改善情況。治療后6個月再次隨訪,評估患者肌力、KPS及ZEW評分。計算接受伽瑪?shù)吨委熀?個月、6個月時兩組患者中KPS評分≥70分、ZEW評分≤3分、肌力Ⅲ級的患者百分比及并發(fā)癥發(fā)生率。采用兩獨立及配對樣本的t檢驗分析計量資料,定性資料的比較采用X~2檢驗。結果:DTI組患者出院前運動功能緩解率(69%)高于對照組患者(52%),但差異無統(tǒng)計學意義(X~2=1.626,P=0.266)。伽瑪?shù)吨委熀?個月兩組患者的腫瘤控制率、并發(fā)癥發(fā)生率、患肢肌力及KPS評分均無統(tǒng)計學意義(P=0.430;P=0.495;P=0.498;P=0.457),而ZEW評分差異有統(tǒng)計學意義(X~2=5.638,P=0.035)。伽瑪?shù)吨委熀?個月DTI組患者的并發(fā)癥發(fā)生率明顯低于對照組(X~2=5.115,P=0.044),DTI組治療前有肢體活動障礙的患者肌力穩(wěn)定情況優(yōu)于對照組(X~2=5.955,P=0.028);DTI組患者KPS評分及ZEW評分均優(yōu)于對照組(X~2=5.409,P=0.036;X~2=4.893,P=0.048)。結論:將DTI應用于伽瑪?shù)吨委熌X運動功能區(qū)腫瘤可以較為準確地判斷腫瘤與錐體束的關系,實現(xiàn)個體化的方案制定,在保證腫瘤局部控制率的同時最大程度地保護患者的神經(jīng)功能,降低并發(fā)癥發(fā)生率,提高患者遠期生存質(zhì)量,從而達到“病變消除最大化,功能損傷最小化”的目標。
[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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