多模态三维影像融合技术在颅内功能区病变手术中的应用  

Multimodality fusion and three-dimensional reconstruction technology in surgical treatment of eloquent area lesions

作　　者：马木提江·木尔提扎 汪永新[1] 阿西木江·阿西尔 姜彦文 秦虎[1] Mamutijiang Muertizha;Wang Yongxin;Aximujiang Axier;Jiang Yanwen;Qin Hu(Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院神经外科中心,乌鲁木齐830054

出　　处：《中华神经创伤外科电子杂志》2023年第5期302-307,共6页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：新疆维吾尔自治区自然科学基金-联合基金项目(2021D01C339);新疆医科大学第一附属医院2022年度“青年科研起航”专项基金。

摘　　要：目的探讨基于3D-slicer软件的影像后处理三维重建可视化技术在颅内功能区病变手术中的作用。方法选取2021年5月至2022年6月于新疆医科大学第一附属医院神经外科接受手术治疗的31例累及功能区病变的患者为研究对象,利用3D-slicer软件对术前增强MRI、弥散张量成像(DTI)、MRI或CT血管成像等影像结果进行三维重建及融合处理,将病变与附近颅骨、大脑沟回、神经传导束以及血管的相对关系可视化,并以最大范围安全切除的原则设计最佳手术方案。术后复查MRI并结合术中情况判断肿瘤切除程度,以卡氏功能评分(KPS)和波士顿诊断性失语症检查(BDAE)程度分级表进行功能评估和记录。结果所有患者的影像资料经多模态融合和三维重建后均可清晰显示病灶的具体部位,其中累及运动感觉区19例、语言区13例,肿瘤最大直径22.0~90.1 mm。术后全切26例,次全切4例,大部分切除1例。病理结果为胶质瘤(WHO 2~4级)21例,转移瘤2例,脑膜瘤5例,淋巴瘤1例,罗道病1例,包虫病1例。术后神经功能障碍症状改善者23例,无变化者5例,加重者3例。患者手术前后的KPS评分和BDAE分级的差异存在统计学意义(P<0.05)。结论基于3D-slicer软件进行影像后处理三维重建可视化可清楚显示大脑功能区病变与对应脑表面形态的关系,有助于评估病变范围与对周围神经传导束侵犯情况,从而最大范围切除病变且保留重要神经功能。Objective To assess the clinical value of multimodality fusion and three-dimensional(3D)reconstruction technology in surgical treatment of eloquent area lesions.Methods Thirty-one patients with functional area lesions who underwent surgical treatment at the Neurosurgery Department of the First Affiliated Hospital of Xinjiang Medical University from May 2021 to June 2022 were selected as the research subjects.3D slicer software was used to perform 3D reconstruction and fusion processing on preoperative enhanced MRI,diffusion tensor imaging(DTI),MRI or CT vascular imaging results.The relative relationship between the lesion and the nearby skull,cerebral sulcus,nerve conduction bundle,and blood vessels was visualized,and the optimal surgical plan was designed based on the principle of maximum safe resection.Follow up MRI after surgery and assess the degree of tumor resection based on intraoperative conditions.The Karnofsky performance status(KPS)and Boston diagnostic aphasia examination(BDAE)were used to evaluate the neurological function status.Results The imaging data of all patients can clearly display the specific location of the lesion through multimodal fusion and 3D-reconstruction technology,including 19 cases involving the sensorimotor area and 13 cases involving the linguistic function.The maximum diameter of the tumor is 22.0-90.1 mm.A total of 26 patients underwent gross total resection,while subtotal resection in 4 cases and partial resection in one case.Pathological results showed glioma(WHO grade 2-4)in 21 cases,metastatic tumor in 2 cases,meningioma in 5 cases,lymphoma in 1 case,Rosai Dorfman disease in 1 case,and echinococcosis in 1 case.Postoperative improvement of neurological function was found in 23 cases,while no changes in 5 cases and deteriorations in 3 cases.The changes of KPS score and BDAE grading before and after surgery were statistically significant(P<0.05).Conclusion Based on 3D-slicer software for image post-processing and 3D-reconstruction visualization,the relationship between brain

关 键 词：影像后处理 多模态融合 三维重建可视化 功能区病变 

分 类 号：R739.41[医药卫生—肿瘤]