CAJ | 학술논문

目的探讨应用弥散张量成像进行脑神经(CNs)纤维束示踪、可视化重建的可行性,并尝试将其应用于颅底肿瘤术前规划.方法利用3.0T磁共振对10例健康志愿者,10例颅底肿瘤患者进行稳态采集快速成像、弥散张量成像扫描,3D Slicer软件完成脑神经纤维示踪、重建,病变患者重建肿瘤三维影像,通过手术观察及神经电生理监测确认脑神经的位置.结果 CNⅡ、Ⅲ、Ⅴ、Ⅵ、Ⅶ～Ⅷ、Ⅹ、Ⅻ成像良好,肿瘤、水肿与相关脑神经的三维空间关系通过纤维示踪与三维重建得以呈现,经过手术验证准确无误.结论联合应用弥散张量成像及3D Slicer软件是正常及病理状态下脑神经可视化重建切实可行的方案,具有良好的临床应用前景.
목적 탐토응용미산장량성상진행뇌신경(CNs)섬유속시종、가시화중건적가행성,병상시장기응용우로저종류술전규화.방법 이용3.0T자공진대10례건강지원자,10례로저종류환자진행은태채집쾌속성상、미산장량성상소묘,3D Slicer연건완성뇌신경섬유시종、중건,병변환자중건종류삼유영상,통과수술관찰급신경전생리감측학인뇌신경적위치.결과 CNⅡ、Ⅲ、Ⅴ、Ⅵ、Ⅶ～Ⅷ、Ⅹ、Ⅻ성상량호,종류、수종여상관뇌신경적삼유공간관계통과섬유시종여삼유중건득이정현,경과수술험증준학무오.결론연합응용미산장량성상급3D Slicer연건시정상급병리상태하뇌신경가시화중건절실가행적방안,구유량호적림상응용전경.
Objective To investigate the feasibility of 3-dimensional reconstruction of cranial nerves (CNs) via diffusion imaging tractography,and attempt to apply in the preoperative plan of skull base tumor.Methods 3-Tesla magnetic resonance imaging scans,including 3D-FSPGR,FIESTA and DTI,were used to collect information of 10 healthy subjects and 10 skull base tumor patients.DTI data were integrated into the 3D-Slicer for fiber tracking,overlapped anatomic images to determine course of nerves.3D reconstructions of tumors were achieved to perform neighbor,encasing,invading relationship between lesion and nerves whose location was then recorded during surgery by surgical observation and neurophysiological monitoring.Results Detailed fibers of the cranialnerves were depicted.Optic pathway showed perfect 3D streamline body,especially the posterior of optic chiasm.Oculomotor nerve coursed from the brainstem to the cavernous sinus distally,which also had high fidelity.Trigeminal nerve allowed visualization of gasserian ganglion as cisternal segment.Cisternal parts of abducent nerve,facial/ vestibulocochlear nerve,vagus nerve,hypoglossal nerve were also imaged well.Moreover,the 3D-spatial relationship between CN and skull base tumor estimated preoperatively by tumor modeling and tractography corresponded to the results determined during surgery.Conclusions Supported by DTI and 3D Slicer,3D reconstruction of cranial nerve is feasible in normal and pathological circumstances.It will have a satisfactory clinical application perspective and greatly expand the scope of minimally invasive neurosurgery.