超声融合导航技术在脑肿瘤切除术中的初步应用  

The application of volume navigation with ultrasound and MR fusion image in neurosurgical braintumor resection

作　　者：邬冬芳[1] 何文[1] 林松[2] 韩波[2] 任晓辉[2] 魏世纪 刘梦泽 Wu Dongfang;He Wen;Lin Song;Han Bo;Ren Xiaohui;Wei Shiji;Liu Mengze(Department of Ultrasound,Beijing Tiantan Hospital,Capital Medical University,Beijing 100160,China)

机构地区：[1]首都医科大学附属北京天坛医院超声科,100160 [2]首都医科大学附属北京天坛医院神经外科,100160

出　　处：《中华超声影像学杂志》2018年第12期1036-1041,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金面上项目(81071239).

摘　　要：目的初步探讨超声融合导航技术在神经外科肿瘤切除术中应用的可行性。方法30例行脑肿瘤切除术患者开颅前分别应用融合超声导航功能和神经外科医生"认知融合"确定骨瓣位置、大小,记录完成所需要的时间。开颅后首先应用常规超声定位肿瘤位置,之后应用容积导航技术分别实时对比分析肿瘤相同平面的超声及超声造影与CT或磁共振图像。结果融合超声导航开颅前可快速确定术窗骨瓣的位置及大小,所有患者的肿瘤均可充分暴露于显微镜视野内。30例患者应用融合导航技术26例自动成功配准;3例脑胶质瘤(WHOⅠ~Ⅱ级)和1例病理为炎性组织的患者常规超声识别肿瘤不明确,应用融合(超声/磁共振)导航后可准确定位肿瘤。超声造影与增强磁共振相比较,高级别脑胶质瘤超声造影表现为动脉期快速强化,肿瘤边界清晰,其增强模式和磁共振增强模式完全相同;低级别胶质瘤超声造影病灶表现为动脉期内缓慢散在的点状或线状强化,肿瘤强化边界模糊,术前磁共振T1增强加权相中肿瘤无强化。结论融合超声导航可用于开颅前确定开颅骨瓣位置及大小;低级别脑胶质瘤更适合与术前磁共振T2Flair相融合,用于肿瘤定位;高级别脑胶质瘤适合与术前T1增强加权相融合,用于肿瘤边界的判定。Objective To observe the feasibility in neurosurgical brain tumor resection using ultrasound fusion navigation technology.Methods Thirty patients undergoing brain tumor rescetion accepted fusion ultrasound(US)navigation with magnetic renounce/computed tomography(MR/CT)technique and "cognitive fusion" by neurosurgeon based on the tumor's localization of magnetic renounce imaging(MRI)separately to definite the position and size of the craniotomy window flaps.After removal cranial bone,conventional B-mode ultrasound scanning was used to detect lesion firstly.Then,fusion US/MR navigation was applied again after automatically registration;the images of tumors from B-mode ultrasound and contrast-enhanced ultrasound separately were compared to those from coplanar reconstructive MR/CT in a real time.Results Fusion US/MR navigation was useful to define the position and size of the craniotomy window flaps,and tumors in all patients were fully exposed to the microscope field of view.In all of 30 cases,26 cases of fusion imaging of volume navigation technology were successfully registrated.The tumors in 3 cases of glioma(WHOⅠ-Ⅱ grade)and 1 patient with pathologically verified inflammatory couldn't be localized by conventional B-mode ultrasound but could be accurately localized after fusion(US/MR)imaging navigation.Compared to contrast-enhanced MR,high-grade glioma with contrast-enhanced ultrasound(CEUS)showed enhancement in arterial phase and clear tumor boundary rapidly.The enhanced modality with CEUS and MR was functioned equal.Low-grade glioma with CEUS showed scattered point or linear enhancement in arterial phase and the tumor's margin was blurred.The preoperative T1-weighted enhanced MRI demonstrated no enhancement in the low-grade glioma.Conclusions Fusion ultrasound navigation can be used to definite size of bone flap before craniotomy.It is more suitable for fusion with preoperative T2Flair phase to localize low grade glioma.High-grade glioma is suitable to preoperative T1 weighted enhanced phase for discerning

关 键 词：超声检查 脑肿瘤 融合超声 术中导航 

分 类 号：R445.1[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]