摘要
目的利用多模态影像融合技术联合血氧饱和水平依赖的功能磁共振成像（BOLD—fMRI）构建中央区脑肿瘤及其周围解剖结构，为肿瘤切除手术提供指导。方法回顾性纳入2015年4月至2015年11月清华大学医学中心，清华大学玉泉医院神经外科收治的5例中央区脑肿瘤患者，采用头颅CT、MRI及BOLD．fMRI对患者进行数据采集，利用NeuroTech软件对CT、MRI数据进行配准融合和三维重建，利用IViewbold软件对BOLD—fMRI数据进行分析处理。根据影像学结果设计手术切口、手术入路，在显微镜下行肿瘤切除手术。结果三维重建后可清晰显示肿瘤的大小、部位、形状以及肿瘤与周围结构的解剖关系；BOLD-fMRI还可进一步显示肿瘤与皮质运动区的解剖关系。全切除5例，术后1例肢体肌力改善，1例语言功能改善，1例出现癫痫，2例未出现新发症状或原有症状加重。术后MRI检查均未见肿瘤残留，其中1例术后行MRI及BOLD—fMRI均显示中央沟静脉和皮质运动区保留。随访时间为3—11个月，平均（4．6±3．2）个月。复查头颅MRI均未见肿瘤复发。3例患者肢体肌力改善，1例语言功能改善，1例癫痫症状缓解。结论多模态影像融合技术联合BOLD—fMRI能直观显示中央区肿瘤与周围组织及皮质运动区的解剖关系，为手术切口的设计、手术入路的选择、肿瘤切除及脑功能保护发挥重要作用。
Objective To construct brain tumors in the central region and their surrounding anatomical structures with the method of multimodal image fusion and BOLD （blood oxygen level dependent）-fMRI and provide surgical guidance. Methods The CT, MRI and BOLD-fMRI data of 5 patients with brain tumor in the central region were collected, who were admitted to Department of Neurosurgery, Yuquan Hospital,Tsinghua University from April 2015 to November 2015. The patients＇ CT and MRI images were fused and 3D-reconstructed using the NeuroTech software. The BOLD-fMRI data was analyzed with the software of IViewbold. Based on the images, the surgical incision and approach were designed and total resection of tumors was performed. Results In all 5 cases, the features of their brain tumors in the central region including size, location, shape and spatial relationship with surrounding structures were clearly demonstrated in 3D-reconstructed images. BOLD-fMRI could supply more precise information about the relationship between the tumor and surrounding motor cortex. Postoperatively, increased muscle strength was observed in 1 case, improved language function was reported in 1 case and 1 patient developed epilepsy. The other 2 patients did not develop new symptoms or report deterioration of original symptoms. No residual tumors were shown at postoperative MRI images in this study. Postoperative MRI and BOLD-fMRI examination of I patient demonstrated that the central sulcus vein and cortical motor cortex were preserved. The follow-up period lasted 3-11 months with an average of （4.6±3.2） months and no brain tumor recurrence was observed based on MRI reexamination. Improved muscle strengths and language function were observed in 3 cases and 1 case, respectively. The patient with epilepsy demonstrated symptomatic relief. Conclusion A combination of multimodal image fusion and BOLD-fMRI could clearly demonstrate the anatomical relationship of brain tumors in the central region to their surrounding structures and motor cortices, which might be useful for design of surgical incision, plan of surgical approach, resection of brain tumors and protection of brain functions.
作者
李杰飞
张玉琪
何乐
左焕琮
Li Jiefei Zhang Yuqi He Le Zuo Huancong(Medical Center, Tsinghua University, Department of Neurosurgery , Yuquan Hospital, Tsinghua University ,Beijing 100084, China)
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第3期255-259,共5页
Chinese Journal of Neurosurgery
基金
清华-裕元医学科学研究基金（20240000513）
关键词
脑肿瘤
神经外科手术
成像
三维
多模态
功能磁共振成像
Brain neoplasms
Neurosurgical procedures
Imaging, three-dimensional
Muhimodal imaging
Magnetic resonance imaging
