全息影像在经会阴前列腺靶向穿刺中的应用  

Application of holographic image in transperineal prostate targeted biopsy

作　　者：汪磊[1] 赵子臣[1] 果宏峰[1] 那曼丽 李梦参 王义[1] 李宁忱[1] 那彦群[1] Wang Lei;Zhao Zichen;Guo Hongfeng;Na Manli;Li Mengshen;Wang Yi;Li Ningchen;Na Yanqun(Peking University Shougang Hospital,Wujieping Urology Center,Beijing 100144,China;Department of Medical Imaging,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学首钢医院吴阶平泌尿外科医学中心,北京100144 [2]北京大学首钢医院医学影像科,北京100144

出　　处：《中华泌尿外科杂志》2022年第2期111-115,共5页Chinese Journal of Urology

摘　　要：目的探讨全息影像引导经会阴前列腺靶向穿刺的可行性和准确性。方法回顾性分析2020年5—9月北京大学首钢医院收治的10例行全息影像引导经会阴前列腺靶向穿刺患者的临床资料。平均年龄(70.9±10.3)岁。PSA中位值15.1(6.02~1110.14)ng/ml。前列腺MRI检查PI-RADS评分均≥3分,可疑靶病灶数量(1.4±0.5)个。患者取轻度截石体位,会阴部和下腹部皮肤粘贴定位贴,行泌尿系CT检查。将CT和MRI检查数据分别制作为全息影像模型并融合为完整模型,针对靶病灶规划穿刺路径。穿刺时患者取与CT检查相同体位,术者佩戴混合现实头戴式显示器(HoloLens眼镜),利用皮肤定位贴进行全息模型与真实人体的视觉配准。然后在虚拟穿刺路径引导下置入穿刺活检枪,到达预定深度后击发,置入经直肠超声明确穿刺针位置,通过超声与MRI图像比对判断穿刺的客观准确性。如首次击发判断为欠准确,允许调整角度后补充击发1次。全息影像引导穿刺完成后,行认知融合靶向穿刺及12针系统穿刺,分别计算3种穿刺方式的阳性针数比例。结果本组10例穿刺均顺利完成,共行全息影像靶向穿刺16针,认知融合靶向穿刺28针,系统穿刺116针。全息靶向穿刺首次击发的客观准确率为68.8%(11/16),补充击发后的准确率提升为87.5%(14/16)。全息影像靶向穿刺、认知融合靶向穿刺、系统穿刺的阳性针数比例分别为56.3%(9/16)、42.9%(12/28)和19.8%(23/116),差异有统计学意义(P=0.002)。主观调查问卷结果显示,全息影像模型有助于提高术者对病灶的空间认识,术中全息配准和引导穿刺的满意度分别为90%和60%。本组10例均未发生穿刺相关并发症。结论全息影像引导经会阴前列腺靶向穿刺具有可行性,且有较好的客观准确性,穿刺阳性针数比例优于系统穿刺。Objective To investigate the feasibility and accuracy of transperineal prostate targeted biopsy guided by holographic image.Methods Clinical data of 10 patients with transperineal prostate targeted biopsy guided by holographic image in Peking University Shougang Hospital between May and September 2020 were analyzed retrospectively.The average age was(70.9±10.3)years old,the median PSA was 15.1(6.02-1110.14)ng/ml,prostate MRI were performed before biopsy and the PI-RADS scores were all≥3,and the number of suspicious target lesions was 1.4±0.5.CT examinations of urinary system were performed on the premise of mild lithotomy position and positioning stickers pasted on the skin of perineum and lower abdomen.The original data of CT and MRI were obtained,holographic image models were firstly made separately and then fused into a complete model,and the puncture paths were planned for the target lesions.At the time of puncture,the patient took the same body position as in CT scan,the operator wore a mixed reality head mounted display(HoloLens glasses),and the skin positioning stickers were used for visual registration between the holographic model and the real human body.Then under the guidance of the virtual puncture path,the puncture biopsy gun was placed,fired after reaching the predetermined depth,a transrectal ultrasound probe was placed to clarify the position of the puncture needle,and the objective accuracy of puncture was judged by comparison of ultrasound and MRI images.If the first shot was judged to be inaccurate,it was allowed to make a supplementary shot after adjusting the angle.After holographic guided biopsies,cognitive fusion targeted biopsies and 12-needle systematic biopsies were performed routinely,and the proportion of positive needles of the three different biopsy methods were calculated respectively.Results All the 10 cases were successfully completed,including 16 holographic image guided shots,28 cognitive fusion targeted shots and 116 systematic shots.The objective accuracy of holographic im

关 键 词：前列腺肿瘤 全息影像 三维可视化技术 前列腺穿刺 

分 类 号：R737.25[医药卫生—肿瘤]