The Application Of MRI-DTI And BOLD-fMRI Combined With FLs In The Treatment Of HGG In Motor Function Area

Objective:To study the value of comprehensive application of DTI,BOLD-fMRI and FLs in the surgery of HGG which located in motor function area.Methods:In the study group,20 complete data cases were selected from the Department of Neurosurgery,First Affiliated Hospital of Shenzhen University from January 2016 to June 2018.All cases showed that the tumor was located in the motor function area or near the motor function area.All of them were confirmed by pathology as HGG.Before the operation,all patents'BOLD-fMRI and DTI data were processed by the imaging physician and recorded into the disc.Then the neurosurgery performed data fusion on the Medtronic nerve navigation instrument,showing the spatial positional relationship between the functional cortex and the cortical fiber bundle and the brain tumor,designing a suitable surgical incision and approach.Within the allowable safety range,tumors were excised according to the tumor boundaries indicated by sodium fluorescein staining with IONM.In the control group,Twenty patients were selected by a 1:1 matched manner.The matching indicators include age,location of lesions,preoperative KPS and preoperative muscle strength.The tumor was excised using a conventional surgery method with IONM.In both groups,the MRI enhanced scan was performed within 72 hours after surgery,then the degree of tumor resection was evaluated.We respectively recorded the KPS scores and the muscle strength of the contralateral limbs at 1 week and 1 month after surgery.The degree of tumor resection,muscle strength and KPS scores were compared between the two groups.The role of DTI and BOLD-fMRI combined with FLs in the surgery of HGG in motor function area was evaluated.Results:(1)All cases in the study group could reconstruct the white matter fiber bundles.90%of the cases can reconstruct the cortex of motor functional area.There is a close spatial relationship between the DTI and BOLD imaging;(2)In the study group,the spatial positional relationship of the fiber bundles indicated by preoperative DTI was correlated with the extent of tumor resection,(34)~2=7.712,P<0.05;(3)The spatial positional relationship of the fiber bundles in the study group was correlated with the change of postoperative muscle strength,(34)~2=8.299,P<0.05;(4)The total tumor resection and near total resection rate was 85%in the study group while 55%in the control group,(34)~2=4.286,P<0.05.There was a statistically significant difference in tumor resection rates between the two groups.Conclusion:DTI and BOLD imaging techniques can show the spatial positional relationship among the tumor,functional cortex and cortical fiber bundle under neuronavigation.It is conducive to the design of the surgical approach,predicting the scope of tumor resection and predicting postoperative muscle strength.FLs help to identify the tumor,guide surgical resection,and improve the rate of tumor resection.