The Guidance Of Preoperative White Matter DT-FT Imaging Of Supratentorial Brain Tumors For Surgery

Objective: To investigate the relationship between the category of tumor, clinical syndromes and the types of the tract's lesions by diffusion tensor imaging, especially diffusion tensor fiber tracking for the supratentorial brain tumors. To explore the value of the DTI, DT-FT in the operation of brain tumor in terms of surgical planning, avoiding the important fiber bundle structures effectively.Methods: This study comprises two parts. Part I: 40 patients with brain tumors in the supratentorial areas were selected as the experimental group from January 2010 to January 2011, Tongji Hospital. All were right-handed, and pathological types were not limited. All patients underwent conventional MRI, including unenhanced and enhanced scans to determine the tumors'location, size, extent of edema, adjacent relationship with the surrounding fiber structures. And all patients underwent GE 3.0T MRI diffusion tensor imaging and diffusion tensor fiber tracking to analyze the relationship between the fiber bundles and the tumor by the GE ADW 4.4 workstation. To collect the information of the relationship between fiber bundles, types of lesion and clinical manifestations and pathological data by imagines to analyze the dependability. Part II: Choose 32 patients with the tumor in the frontal and parietal lobes from 40 patients aforesaid as experimental group; experimental group underwent conventional MRI, DTI and the DT-FT imaging. All these were measured the number of CST before and after operation, muscle strength and other physical activities. And 20 patients with frontal and parietal lobes are selected who did not undergo the DT-FT imaging as the control group at the same time. They underwent plain and enhanced MRI scans only. Measure the preoperative symptoms. The number of fiber bundles before and after the operation was statistically compared in experimental group. Both groups underwent routine postoperative MRI and DTI, DT-FT imagines to statistically compare the rates of total tumor resection, changes in muscle strength 2 weeks later after the operation. From these compares we can try to explore the value of DTI, DT-FT in the operation of brain tumors in the functional areas.Results: Part I: 1. The lesions of fiber bundles were related to the pathological types of tumors: (1) Fiber's simple shift is mainly induced by meningiomas and pristine low-grade gliomas in the early period; (2) The infiltration and partly damaged are mainly induced by malignant tumors such as low-grade gliomas and malignant meningiomas, what grow invasively; (3) The completely interruption of fiber bundles is mainly induced by invasive high-grade gliomas and metastatic carcinomas. 2. the lesions of fiber bundles related to clinical symptoms: According to the reconstruction results of DT-FT,11 cases whose fiber bundles are shifted by the tumor had normal muscle strength or only slightly decreased; 20 cases whose fibers are partial infiltrated , the damage to the anterior and middle part of the fiber bundles by tumor invasion caused moderate paralysis of the contralateral upper limb in 3 cases and severe paralysis in 7 cases , slight paralysis in 6 cases and moderate paralysis of contralateral lower limbs in 5 cases; the damage to the posterior part of the fiber bundles caused moderate paralysis of the contralateral upper limb in 2 cases and severe paralysis in 1 cases, meantime moderate paralysis of the contralateral lower limb in 3 cases and severe paralysis in 1 cases ; 9 patients with completely interrupted, all appeared severe paralysis.PartⅡ: 1.The change of the imaged number of fiber bundles of the experimental group before and after surgery was statistically significant, to determine the operation program by DTI, DT-FT imaging can reduce the damages to fiber bundles in operation; 2. The ratios of total resection of tumor and motor dysfunction were statistically significant between the patients DTI, DT-FT imaging done and undone.Conclusion: The dependability is existed between the category of tumors, clinical syndromes and the form of fiber bundles'lesions induced the tumor. The application of DTI and DT-FT can significantly improve the rate of total resection of tumor; reduce surgical morbidity, avoid important and fiber bundles effectively in the operation.