基于代谢影像的多模态功能神经导航在无框架立体定向穿刺活检术中的应用  

Integration of metabolism images into multimodal neuronavigation for frameless stereotax3

作　　者：李昉晔[1] 陈晓雷[1] 何婷婷[2] 张家墅[1] 宋志军[1] 李晋江[1] 郑刚[1] 胡深[1] 张挺[1] 许百男[1] 

机构地区：[1]解放军总医院神经外科,北京100853 [2]解放军总医院核医学科,北京100853

出　　处：《中华外科杂志》2013年第4期358-361,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（81271515）;北京市自然科学基金资助项目（7102145）;军队临床高新技术重大项目（2010gxjs094）;首都临床特色应用研究重点项目（Z111107058811017）

摘　　要：目的评价基于代谢影像的多模态功能神经导航在无框架立体定向穿刺活检术中的应用价值。方法2012年1月至12月32例患者接受基于PET、氢质子磁共振波谱（^1H—MRS）等代谢影像的多模态功能神经导航和术中磁共振（iMRI）引导下颅内病变无框架立体定向穿刺活检术。其中男性16例，女性16例；年龄7～62岁，平均45岁。根据PET和^1H—MRS确定活检靶点，记录诊断阳性率、并发症等。结果所有患者均成功实施基于代谢影像的多模态导航和iMRI引导下立体定向穿刺活检术。iMRI证实术中穿刺点和活检计划靶点吻合，术后标本均获得明确的病理诊断，诊断阳性率100％。1例患者出现穿刺靶点小血肿（〈5m1），未手术处理，手术并发症发生率3．1％。所有患者术后均未出现新发神经功能障碍或原有症状加重。结论基于代谢影像的多模态功能神经导航可提供生化代谢、功能、解剖信息，提高病变诊断阳性率，避免术后神经功能障碍。Objectives To evaluate the efficacy of integration of metabolism images into multimodal neuronavigation for frameless stereotactic biopsy. Methods From January to December 2012, 32 patients with brain lesions underwent frameless stereotactic biopsy guided by positron emission tomograph（PET） and proton magnetic resonance spectroscopy （IH-MRS）-based muhimodal neuronavigation and intraoperative magnetic resonance imaging（iMRI）. The cohort consisted of 16 male and 16 female patients, with a mean age of 45 years （range： 7-62 years）. Biopsy targets were identified according to PET and ill-MRS. Biopsy was performed with Varioguide frameless biopsy system. Diagnostic yield and complications were assessed. Results Metabolism images-based muhimodal neuronavigation and iMRI were successfully implemented in all cases, iMRI confirmed accuracy of biopsy targets. All the specimens obtained pathological diagnosis, the diagnostic yield was 100~/o. In 1 patient, iMRI found small hematoma （ 〈 5 ml） , surgical evacuation wasn＇t needed with intraoperative complication rate 3.1%. With the help of multimodal neuronavigation, no patients had new or worsened neurologic deficits. Conclusions Integration of metabolism images into muhimodal neuronavigation provide not only anatomical, but also metabolic and functional information for frameless stereotaxy, increasing diagnostic yield and avoiding postoperative neurologic deficits.

关 键 词：活组织检查 神经导航 诊断 计算机辅助 磁共振成像 

分 类 号：R651[医药卫生—外科学]