This pilot study aimed to investigate the interest of high angular resolution diffusion imaging (HARDI) and tractography of the spinal cord (SC) in the management of patients with intramedullary tumors by providing predictive elements for tumor resection. Eight patients were included in a prospective study. HARDI images of the SC were acquired using a 3T MRI scanner with a reduced field of view. Opposed phase-encoding directions allowed distortion corrections. SC fiber tracking was performed using a deterministic approach, with extraction of tensor metrics. Then, regions of interest were drawn to track the spinal pathways of interest. HARDI and tractography added value by providing characteristics about the microstructural organization of the spinal white fibers. In patients with SC tumors, tensor metrics demonstrated significant changes in microstructural architecture, axonal density, and myelinated fibers (all,p< 0.0001) of the spinal white matter. Tractography aided in the differentiation of tumor histological types (SC-invaded vs. pushed back by the tumor), and differentiation of the spinal tracts enabled the determination of precise anatomical relationships between the tumor and the SC, defining the tumor resectability. This study underlines the value of using HARDI and tractography in patients with intramedullary tumors, to show alterations in SC microarchitecture and to differentiate spinal tracts to establish predictive factors for tumor resectability.
本初步研究旨在探讨高角分辨率扩散成像（HARDI）及脊髓纤维束成像在髓内肿瘤患者治疗中的应用价值，通过提供肿瘤切除的预测性要素。研究纳入了八名患者进行前瞻性分析。采用3T磁共振成像仪配合小视野扫描获取脊髓HARDI图像，通过反向相位编码方向实现畸变校正。采用确定性方法进行脊髓纤维束追踪，并提取张量指标。随后划定感兴趣区域以追踪目标脊髓传导通路。HARDI与纤维束成像技术通过提供脊髓白质纤维微观结构特征信息展现附加价值。在脊髓肿瘤患者中，张量指标显示脊髓白质的微观结构、轴突密度及髓鞘纤维均发生显著改变（所有指标p<0.0001）。纤维束成像有助于区分肿瘤组织学类型（脊髓受侵型与肿瘤推挤型），并通过传导通路的鉴别明确肿瘤与脊髓的精确解剖关系，从而界定肿瘤可切除性。本研究证实了HARDI与纤维束成像技术在髓内肿瘤患者中的应用价值，既能显示脊髓微观结构改变，又可区分脊髓传导通路，为肿瘤可切除性建立预测因素。
肿瘤(癌症)患者之家