扩散张量成像(DTI)在难治性癫痫患者的 手术前评估中的应用进展
Advances in the Application of Diffusion Tensor Imaging (DTI) in the Preoperative Evaluation of Drug-Resistant Epilepsy
摘要: 药物难治性癫痫的手术效果在很大程度上依赖于术前评估的精确性。扩散张量成像(DTI)通过测量水分子扩散特性并重建白质纤维束，为识别致痫网络、保护关键通路、设计手术路径以及预测手术结果提供了重要的支持。近年来，DTI在识别颞叶癫痫的白质微结构异常、辅助定位MRI阴性病例、保护视辐射和语言相关通路、预测术后发作及认知结果，以及与SEEG和消融等微创技术的结合方面取得了显著进展。然而，DTI仍然受到单张量模型的局限、参数病理特异性不足、方法学的多样性以及术中脑移位等因素的影响。未来应推动数据采集与后处理的标准化、多模态的整合以及前瞻性多中心的验证，以提高其在药物难治性癫痫术前评估中的临床可重复性和决策价值。
Abstract: The surgical outcome of drug-resistant epilepsy (DRE) depends heavily on the accuracy of preoperative evaluation. Diffusion tensor imaging (DTI) enables noninvasive assessment of white-matter microstructure and fiber tract architecture by quantifying the directional properties of water diffusion. As a result, it provides valuable information for epileptogenic network inference, protection of eloquent white-matter pathways, surgical trajectory planning, and prediction of postoperative outcomes. Recent studies have expanded the role of DTI from identifying microstructural abnormalities in temporal lobe epilepsy to assisting lesion detection in MRI-negative epilepsy, delineating the optic radiation and language-related pathways, predicting seizure and cognitive outcomes, and supporting stereo-electroencephalography and ablative strategies. Nevertheless, its clinical translation is still constrained by the limitations of the single-tensor model, the limited pathological specificity of DTI metrics, methodological heterogeneity across centers, and spatial mismatch caused by intraoperative brain shift. Future efforts should focus on standardized acquisition and post-processing, multimodal integration, and prospective multicenter validation to improve the reproducibility and decision-support value of DTI in the preoperative assessment of DRE.
文章引用：徐伟竣, 石全红. 扩散张量成像(DTI)在难治性癫痫患者的 手术前评估中的应用进展[J]. 临床医学进展, 2026, 16(4): 1704-1716. https://doi.org/10.12677/acm.2026.1641409

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