一种C型臂X线卵圆孔成像方法的建立与临床验证  

Establishment and clinical verification of a C-arm X-ray foramen ovale imaging method

作　　者：刘展[1] 陶胜忠[1] 卢慧鹏 王艮卫[1] 耿晓腾 尹梦磊 马帅 睢豫擘 Liu Zhan;Tao Shengzhong;Lu Huipeng;Wang Genwei;Geng Xiaoteng;Yin Menglei;Ma Shuai;Sui Yubo(Department of Neurosurgery,the Second Afiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Neurosurgery,the First People's Hospital of Pingdingshan,Pingdingshan 467000,China)

机构地区：[1]郑州大学第二附属医院神经外科,郑州450000 [2]平顶山市第一人民医院神经外科,平顶山467000

出　　处：《中华神经外科杂志》2024年第1期67-72,共6页Chinese Journal of Neurosurgery

基　　金：2022年度河南省科技攻关项目(222102310714)。

摘　　要：目的建立一种C型臂X线卵圆孔成像方法并进行临床验证。方法收集2020年6月至2022年12月于郑州大学第二附属医院神经外科就诊并接受头颅薄层CT扫描患者(虚拟成像组,90例)的影像学资料,基于头颅CT三维重建图像进行卵圆孔模拟成像。前瞻性纳入2022年1月至2023年6月于郑州大学第二附属医院神经外科接受经皮穿刺三叉神经半月节球囊压迫术治疗的原发性三叉神经痛患者(真实穿刺组,12例),术中进行C型臂X线卵圆孔成像;患者取平卧位,标记鼻小柱下缘点(A点)及两侧眶外侧缘与颧弓上缘延长线的交点(B、C点)。沿水平轴旋转C型臂,确定B、A、C三点共线后,再于X线下确定A点重合于双侧眶下缘最外端连线,沿滑轨向穿刺侧偏斜球管20~25°,获取卵圆孔投影。将卵圆孔成像效果分为Ⅰ(完整、清晰显像)、Ⅱ(部分显像)、Ⅲ(裂隙样显像)3类。比较虚拟成像组模拟X线透视下与CT图像上卵圆孔Ⅰ类成像的一致性。观察真实穿刺组患者术中卵圆孔的成像效果。结果90例虚拟成像组患者中,Ⅰ类成像75例,Ⅱ类成像8例,Ⅲ类成像7例。与CT三维重建图像比较,模拟X线透视卵圆孔Ⅰ类成像的灵敏度为97.4%,特异度为100%,一致性检验显示一致性好(Kappa=0.92,P<0.001)。在12例患者经皮卵圆孔穿刺过程中,卵圆孔全部完整显像,顺利完成卵圆孔穿刺。结论通过X线面部解剖标志的特定投影确定C型臂的倾斜角度,从而建立的C型臂X线卵圆孔成像方法使多数患者可获得良好的卵圆孔成像效果,在卵圆孔穿刺术中可辅助卵圆孔显像。Objective To establish a C-arm X-ray foramen ovale(FO)imaging method and conduct clinical verification.Methods The imaging data of patients(virtual imaging group,90 cases)who visited the outpatient clinic at the Department of Neurosurgery,the Second Affiliated Hospital of Zhengzhou University and received cranial thin-section CT scans from June 2020 to December 2022 were collected.Simulated imaging of the FO was made based on three-dimensional reconstruction of head CT images.Patients with primary trigeminal neuralgia who underwent percutaneous puncture and balloon compression of the semilunar ganglion of trigeminal nerve at the Department of Neurosurgery of the Second Affiliated Hospital of Zhengzhou University from January 2022 to June 2023 were prospectively enroled into this study(real puncture group,12 cases).C-arm X-ray foramen ovale imaging was performed during the operation.The patient was placed in a supine position.Three points were marked:point A at the lower extreme of the nasal columella and points B and C at the intersection of the lateral margin of the orbit with an extension line of the zygomatic arch.The C-arm was rotated along a horizontal axis until points B,A,and C visually aligned.After confirming in fluoroscopy that point A essentially coincided with the line between the outermost of the bilateral infraorbital margins,the C-arm was rotated towards the puncture side in 20-25°for obtaining an image of FO.The imaging outcomes of the FO were divided into three categories:Ⅰ(complete and clear visualization),Ⅱ(partial visualization),and Ⅲ(slit-like visualization).The consistency of Class Ⅰ visualization of the FO under simulated X-ray fluoroscopy and CT images in the virtual imaging group was analyzed.The imaging result of the FO during surgery in the real puncture group was observed.Results Among the 90 patients in the virtual imaging group,75 had Class Ⅰ visualization of FO,8 had Class Ⅱ visualization,and 7 had Class Ⅲ visualization.Compared with CT images,the sensitivity of Class

关 键 词：卵圆孔 颅底 成像 三维 体层摄影术 X线计算机 三叉神经痛 

分 类 号：R651.11[医药卫生—外科学]