CT和MRI图像配准融合联合3D打印技术在难治性骨盆肿瘤术前规划中的应用  

Application of CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors

作　　者：曲扬[1] 艾松涛[1] 杨飞[2] 张恒辉[2] 汪轶平[3] 陶晓峰[1] 郝永强[2] 戴尅戎[2] 

机构地区：[1]上海交通大学医学院附属第九人民医院放射科,上海200011上海200240 [2]上海交通大学医学院附属第九人民医院骨科上海市骨科内植物重点实验室,上海200011上海200240 [3]上海交通大学机械与动力工程学院生物医学制造与生命工程质量工程研究所,上海200240

出　　处：《上海交通大学学报（医学版）》2017年第9期1238-1244,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学青年基金(81301260);上海市教育委员会高峰高原学科建设计划(20152221);上海市浦江人才计划(15PJD025);上海交通大学医学院Ⅳ类高峰学科项目(GXQ08);上海市第九人民医院临床研究助力计划(JYLJ025)~~

摘　　要：目的·探讨CT、MRI图像配准融合联合3D打印技术,在辅助难治性骨盆肿瘤术前规划中的应用价值。方法·回顾性总结2014年3月至2016年12月于上海交通大学医学院附属第九人民医院接受治疗的难治性骨盆肿瘤病例,术前常规行薄层CT、MRI检查,借助Medraw软件实现CT、MRI图像快速配准融合,精确判定肿瘤安全边界,辅助设计并3D打印个体骨盆肿瘤模型、假体和(或)导板。结果·共纳入难治性骨盆肿瘤患者13例(软骨肉瘤8例、骨肉瘤合并动脉瘤样骨囊肿1例、未分化性肉瘤1例、纤维结缔组织增生性纤维瘤1例、孤立性纤维瘤/血管外皮瘤1例、转移性鳞癌1例),平均年龄(50.0±8.5)岁。基于Enneking分区:Ⅰ区2例、Ⅰ+Ⅱ区2例、Ⅱ+Ⅲ区1例、Ⅰ+Ⅱ+Ⅲ区3例、Ⅰ+Ⅱ+Ⅳ区1例、Ⅰ+Ⅱ+Ⅲ+Ⅳ区1例、Ⅰ+Ⅳ区1例、Ⅱ+Ⅳ区1例、Ⅳ区1例。肿瘤最大直径平均值(15.15±4.81)cm,均未累及盆腔大血管。结合术中肿瘤边界快速冰冻结果及假体安装情况,判断基于融合图像的术前评估、规划的虚拟手术方案与手术的实施一致。结论·薄层CT、MRI图像配准融合联合3D打印技术,可以精确判定难治性骨盆肿瘤边界,辅助临床设计个体化3D打印假体和导板,在难治性骨盆肿瘤术前规划中具有重要的临床应用价值。Objective ： To explore the value of applying CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors. Methods ： A retrospective analysis was performed on the cases with refractory pelvic tumors admitted between March 2014 and December 2016 in Shanghai Ninth People＇s Hospital, Shanghai Jiao Tong University School of Medicine. CT/MRI examinations were performed as a routine pre-surgicat procedure, and the resulting images were subject to rapid registration and fusion with the Medraw software in order to accurately determine the tumor boundaries and to be used as references in designing and making patient-specific tumor models, prostheses, and implants by 3D printing technique. Results A total of 13 cases with refractory pelvic tumors were included in this study （8 cases of chondrosarcoma, 1 case of osteosarcoma with aneurysmal bone cyst, 1 case of dedifferentiated sarcoma, 1 case of fibrous connective tissue hyperplasia, 1 case of solitary fibrous tumor/hemangiopericytoma, and 1 case of metastatic squamous cell carcinoma） with an average age of （50.0±8.5） years. According to the Enneking classification, there were 2 cases in zone 1 ,2inzones Ⅰ＋ Ⅱ ,1 in zones Ⅱ ＋Ⅲ,3inzones Ⅰ＋Ⅱ ＋Ⅲ ,1 in zones Ⅰ＋Ⅱ ＋Ⅳ,1 in zones Ⅰ ＋ Ⅱ ＋ Ⅲ ＋ Ⅳ 1 in zones Ⅰ ＋ Ⅳ, 1 in zones Ⅱ＋ Ⅳ, and 1 in zone Ⅳ. The mean maximal tumor diameter was （15.15±4.81） cm without implicating the pelvic blood vessels. Results from intraoperative frozen section at resection boundaries and the installation of prosthesis showed that the actual surgical procedure was consistent with the surgical planning based on the reported image fusion technique. Conclusion. CT/MRI image registration and fusion technique combined with 3D printing technique can accurately determine the resection boundary of pelvic tumors and assist in designing of individualized prosthesis model and surgical guide, which has a great value in pre-sur

关 键 词：磁共振成像 图像配准 图像融合 3D打印 骨盆肿瘤 术前规划 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.44[医药卫生—诊断学] R738[医药卫生—临床医学]