【作者】 马成；

【导师】 印弘；

【作者基本信息】 第四军医大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 目的观察正常成人脊髓良恶性肿瘤及其他一些椎管内占位性疾病的扩散张量(diffusion tensor imaging,DTI)成像的影像表现,探讨DTI在椎管内良恶性肿瘤及占位性疾病诊断中的应用价值。方法应用Siemens Magnetom Trio Tim 3.0T磁共振扫描装置,1、对20例健康志愿者行常规T1WI、T2WI、液体衰减反转恢复(FLAIR)、扩散张量成像(DTI)序列,分析扫描所得到的正常人群脊髓的FA (Fractional anisotropy)图,定量测量其相应椎体平面脊髓的FA值,提供正常脊髓神经传导束形态图及FA值图。2、对25例椎管内占位的病人进行常规的T1WI、T2WI、及增强扫描,FLIAR、DTI序列及MPRAGE序列扫描,观察所得病变部位的神经传导束形态,分析病变部位FA值的变化,研究DTI在椎管内占位性疾病区分髓内、外及良、恶性肿瘤的优势,为临床提供直观的手术依据。结果1、正常成人脊髓DTI技术清楚显示健康志愿者的颈、胸段经图像处理后脊髓呈上下走行的蓝色神经传导束,于两侧可见左右红色走行的神经根,测量每个脊髓椎体相应水平的神经传导束平均值。2、硬膜下占位:神经纤维瘤,神经鞘瘤多见其次是脊膜瘤,DTI扫描得出脊髓内占位均造成神经传导束受压变形,其周边测量FA值较正常脊髓相同位置FA值无明显差别。3、髓内肿瘤:包括血管瘤、皮样囊肿、上皮样囊肿、畸胎瘤造成脊髓束形态改变,明显受压时由于纤维排列更加紧密外,FA值无差别,星形细胞瘤及室管膜瘤除破坏脊髓内神经传导束正常走行外,其周边FA值较正常人群有明显下降。结论扩散张量成像反映神经传导束解剖形态学变化的常规MR成像。DTI技术是一种非侵袭性、无放射性、简单易得神经传导束MR成像序列,现DTI技术广泛应用在颅内,但本组数据显示,DTI技术在脊髓占位中能利用FA值的改变,快速的反应出椎管内、外,及脊髓神经传导束受肿瘤破坏的情况,可用于良恶性肿瘤的诊断、神经走向、肿瘤与周边正常组织及神经系统的评估,为外科手术提供教直观的手术依据。更多还原

【Abstract】 Objective:To observe the diffusion tensor imageing (DTI) appearance in the normal adult’s and the spinal cord space-occupying lesion (including benign tumor, malignant tumor) and other’s vertebral canal space-occupying lesion, to investigate the application value of the DTI in the diagnosis the inside of vertebral canal benign or malignant space-occupying lesion.Methods:Study were performde on Siemens Magnetom Trio Tim 3.0T MR scanner syste:1. 20 healthy volunteer were scanned by routine T1WI,T2WI,fluid attenuated inversion recovery (FLAIR), diffusion tensor imaging (DTI) sequence, the FA vaule of health adult crowd myeloid were obtained and analysed , and were quantitively measured the FA of correspond centrum ,the common spinal cord nerve conduction tract picture and FA value picture were provided.2. patient with the intravertebral canal space-occupying lesion were scanned by routine T1WI, T2WI, contrast enhancement scanning, FLIAR、DTI and MPRAGE sequence, the nerve conduction tract of diseased region were observed, FA value of diseased region were also analyed. The experiment research the dominance of DTI that were discriminated the benign tumor or malignant tumor, the inside or outside of spinal cord space-occupying lesion.Results:1. The cervicum cord, thoracic cord segments ,above conus medullaris of healthy volunteer were showed clearly by DTI technique. After image processing, the portait nerve conduction tract were taken on blue,and the transversal nerve root were taken on red, the FA mean value of each correspond centrum’s nerve conduction tract were measured .2. The extra-spinal cord epidural space-occupying lesion: In the cold abscess of tubercle , the nerve conduction tract were compressed and distorted by DTI scanning, there was no difference in the FA value among the perimeter and normal spinal cord identical position.3. The intra-spinal cord tumor (including hemangioma, dermoid cyst, epithelial cyst, teratoma), resulted in the distortion of the spinal cord beam, the FA value were lightly upgrade when it was compressed obviously, because of the fiber compactly arrayed. The malignant tumor (neurospongioma and ependymoma) destroyed the normal nerve conduction tract, the FA value of corticospinal tract were significantly lower than the healthy volunteer.Results:Diffusion tensor imaging (DTI) was used as a routine MR imaging, which reflected the change of nerve conduction tract’s anatomic pattern.. DTI technique was a Non-Invasive, non-radiated, easy gained nerve conduction tract MR imaging technique. At present DTI technique were applied widespread on intracranial lesion, but the group’s data displayed ,that DTI technique could detect the change of FA value to diagnose the spinal cord epidural space-occupying lesion, and volantly response the destroy of nerve conduction tract, which could use in the diagnosis of the benign tumor, malignant tumor, nerves morphous,the evaluation between the tumor and normal tissue , nervous system. DTI technique could provide the visualized operation guide for neurosurgery.更多还原