基于薄层MRI的内囊立体定位与可视化研究

发布时间：2018-06-16 22:55

本文选题：内囊 + 断层影像解剖　；参考：《蚌埠医学院》2014年硕士论文

【摘要】：研究背景：随着脑立体定向技术、脑功能成像技术、X-刀、γ-刀技术、微创神经外科技术以及分子生物学技术的发展和进步，功能神经外科立体定向技术、微创神经外科立体定向技术等需求越来越多，因此在大脑薄层MRI图像上对脑实质区域的形态学、三维空间定位及三维可视化进行深入细致的研究，为脑内微小占位性病变进行精确的定位，准确的拟定术前手术方案、精确术中手术实施操作方案提供重要帮助。首先提出内囊（internal capsule）这一名词的是Burdach，它是白质板，位于尾状核、豆状核和背侧丘脑之间。在横断面上，似向外开放的“V”字形，分三部即前肢、后肢和膝部。前肢（又称额部）在尾状核和豆状核之间，向前外方向走形。后肢（又称枕部）向后外方向走形，又分为豆状核后部、豆丘部（豆状核与背侧丘脑之间）和豆状核下部三部分。膝部位于前肢和后肢之间，即“V”字形的交角处。内囊是大脑皮层与大脑皮层下的上行、下行纤维经过的区域。累计内囊的病损比大脑其他区域的病损造成的伤残更为广泛。并且在CT和MRI诊断中，内囊区域的临床意义也很重要。内囊的研究无论是在国内还是国外，主要是关于其结构破坏及功能障碍，而且除了关于内囊基本结构外，还缺乏整体形态学研究。因此，对内囊在断面上的形态进行详细的描述，研究内囊在断面上的非对称性，构建内囊的三维立体定位数据集和三维可视化模型，对于微创神经外科学、医学影像学等提供解剖学资料。本研究是以大脑连合间径线的中点作为原点、前连合与后连合的间径作为Y轴建立起笛卡尔三维坐标系。通过对30例中国健康成人大脑内囊薄层MRI图像的研究，找到内囊在横断面上的形态特征规律；建立关于内囊的外侧边缘及内侧边缘立体定位数据集，分析其在坐标系中的投影图及回归方程；分析内囊的非对称性；重建内囊在大脑中的可视化模型。为功能神经外科立体定向、放射外科立体定向及微创神经外科和研究内囊的发育及其结构与功能的关系提供解剖学基础。第一部分：基于前后连合间径定位体系的大脑内囊断层影像解剖学目的：通过研究以基于AC-PC间线为扫描基线的活体薄层MRI图像，总结大脑内囊在水平切面上的形态学特征及位置变化规律；方法：30名健康的成年志愿者，以大脑连合间径线为扫描基线行颅脑横断层薄层2mm MRI扫描。在微型计算机上将扫描得到的数据以Dicom3.0的格式导入eFilm2.1工作站。使用“3D-Cursor”技术来识别大脑内囊区域，观测、统计其形态特征。结果：识别出在三维薄层MRI图像连续层面上的内囊，并且总结出内囊的形态及位置变化规律。结论：使用“3D-Cursor”技术对照容易识别的冠状面，能够准确识别在横断面薄层MRI图像连续层面上的内囊，为基底节区的病灶定位提供解剖学基础。内囊连续层面的识别分析为临床影像诊断学和大脑的发生发育学提供参考依据。第二部分：内囊内侧缘及外侧缘立体定位数据集的构建及投影回归分析目的：构建内囊内侧边缘及外侧边缘在基于连合间径定位体系中的立体定位数据集；得出内囊在横、矢状面和冠状面的投影图；求出内囊内外侧边缘的回归方程。方法：将30名健康的成年志愿者颅脑横断层MRI图像数据以JPG格式导出并保存，然后再导入Photoshop软件，图像经过严格配准，使基于连合间径的笛卡尔三维坐标系的原点、X轴、Y轴与软件自身的坐标体系重合。分别测量并且记录内囊内侧边缘及外侧边缘的坐标值X、Y值，Z值即为所在层面距离AC-PC平面的层数与层厚的乘积，，所有采样点的坐标值构成内囊在三维坐标系中的立体定位数据集；使用30名志愿者已经获得的数据，在SPSS软件内完成横、矢状面和冠状面的投影图；采用SPSS17.0软件得出内囊在各投影方向的回归方程。结果：构建出正常成年男性及女性内囊内外侧边缘在三维坐标系中的立体定位数据集；统计绘制了横、矢状面和冠状面的投影图；得出了内囊内外侧边缘在各投影平面上的回归方程。结论：内囊在基于连合间径定位体系中的立体定位数据集的构建，横、矢状面和冠状面的投影图以及回归方程的绘制分析，对于应用立体定向技术及功能神经外科学提供解剖学基础；对于揭示大脑深部区域的发生、发育等形态学规律同样具有重要的意义。第三部分：内囊的非对称性研究目的：观测、分析内囊是否存在性别和侧别的非对称性。方法：在微型计算机中使用eFilm工作站，我们选择了30例正常人，男15例，女15例，颅脑横断面MRI图像，选择其中内囊出现的层面，将图像导入Photoshop软件中来测量，进而得出内囊区男、女性左右两侧距正中矢状面的距离，经SPSS17.0软件统计得出男、女性左右两侧距离差异。结果：统计了男、女性两侧内囊在水平面上的映射侧别差异及性别差异。结论：男、女性左右两侧内囊在水平面上的映射关系，是否可以表述为相同性别国人群体两侧内囊以正中矢状面呈“镜像对称”，不同性别国人群体两侧内囊男性较女性大。第四部分：大脑内囊的三维重建与可视化目的：为内囊及邻近周边区域结构的立体定位、放射立体定向、微创神经外科立体定向以及解剖学教学等提供三维可视化模型。方法：在微型计算机上，正常成人5名（没有神经、精神病史及家族史）大脑横断层2mm薄层MRI图像扫描数据以Dicom3.0的格式导入3D-Doctor软件，手动分割内囊、基底核区、侧脑室、脑的表面等感兴趣区，分别用不同的色彩标记，以复杂表面重建方法三维重建上述各个结构。结果：成功重建了内囊、基底核区及侧脑室在大脑中的三维可视化模型，可以任意方位对模型进行旋转，从各个角度再现了内囊、基底核区及侧脑室的三维模型、在大脑中的空间位置以及它们相互之间的位置关系。结论：内囊的三维可视化模型展现了内囊在活体脑中的三维空间结构及毗邻关系，为脑内占位性病变的重建和观测，提供了重要的方法。对立体定向神经外科手术入路的制定、介入放射科放疗计划的实施以及医学教学具有重要的价值。
[Abstract]:Background: with brain stereotactic, brain functional imaging, X- knife, gamma knife, minimally invasive Department of neurosurgery and molecular biology, more and more needs are needed in the functional department of Neurosurgery stereotactic technology and minimally invasive stereotactic technology. Therefore, the brain parenchyma area is on the brain thin layer MRI images. The morphological, three-dimensional and three-dimensional visualization of the domain are studied in detail, which can accurately locate the small space occupying lesions in the brain, accurately formulate the preoperative operation scheme, and provide important help for the operation of the precise operation.
First, the term internal capsule is called Burdach, which is a white matter plate between the caudate nucleus, the lenticular nucleus and the dorsal thalamus. On the cross section, it resembles an outward "V" shape, divided into three parts, the forelimbs, the hind limbs and the knee. The forelimb (also called the forehead) is between the caudate nucleus and the lenticular nucleus, in the forward direction. (also called the pillow), the hind limbs (also called the pillow) In the back direction, it is divided into the rear of the bean shaped nucleus, the bean hillock (the bean nucleus and the dorsal thalamus) and the lower part of the bean nucleus. The knee is located between the forelimb and the hind limbs, between the forelimb and the hind limbs, the intersection of the "V" shape. The inner capsule is the upper part of the cerebral cortex and the cerebral cortex, and the area of the downlink fiber dimension. The cumulative damage of the internal capsule is more than the rest of the brain. The damage caused by lesions is more extensive. In the diagnosis of CT and MRI, the clinical significance of the internal capsule area is also important.
The study of internal capsule is mainly about structural damage and dysfunction. Besides the basic structure of internal capsule, there is still a lack of overall morphological study. Therefore, the morphology of the internal capsule on the cross section is described in detail, the asymmetry of the internal capsule on the section is studied, and the three-dimensional positioning number of the internal capsule is constructed. According to the set and 3D visualization model, we provide anatomical data for minimally invasive Department of Neurosurgery, medical imaging and so on.
This study is based on the middle point of the cerebral commissure diameter line as the origin, the diameter of the anterior commissure and the posterior commissure is used as the Y axis to establish the Cartesian three-dimensional coordinate system. Through the study of the thin layer MRI image of the internal capsule of the brain of 30 healthy adults in China, the morphological characteristics of the inner sac in the cross section are found, and the outer edge and the inner edge of the inner capsule are established. The projection and regression equations in the coordinate system were analyzed, the asymmetry of the internal capsule and the reconstruction of the internal capsule in the brain were analyzed. The relationship between the three-dimensional orientation of the functional department of Neurosurgery, the radiosurgery stereotactic and the development of the minimally invasive Department of neurosurgery and the study of the internal capsule and the structure and function of the internal capsule were provided. The basis of learning.
Part I: sectional anatomy of the internal capsule of the brain based on the anterior and posterior commissure diameter positioning system.
Objective: To summarize the morphological features and position changes of the cerebral internal capsule on the horizontal section of the brain by studying the thin layer MRI images based on the AC-PC line as the scanning baseline.
Methods: 30 healthy adult volunteers were scanned with the 2mm MRI scan on the brain transverse fault line as the baseline of the cerebral commissure line. The data scanned on the microcomputer were introduced into the eFilm2.1 workstation in the format of Dicom3.0. "3D-Cursor" technique was used to identify the internal capsule area of the brain, and the morphological characteristics were observed.
Results: the internal capsule was identified at the continuous level of three-dimensional thin slice MRI images, and the morphology and location of the internal capsule were summarized.
Conclusion: using the "3D-Cursor" technique to compare the easily identified coronal plane, it can identify the internal capsule on the continuous layer of the cross section thin layer MRI image accurately, and provide anatomic basis for the location of the basal ganglia, and the recognition analysis of the inner capsule continuous layer provides the reference for the clinical imaging diagnosis and the development of the brain.
The second part: Stereotactic data set and projection regression analysis of medial margin and lateral margin of internal capsule.
Objective: to construct a stereoscopic positioning data set on the medial and lateral edge of the internal capsule in the system based on the junction diameter, and to obtain the projection of the internal capsule in the transverse, sagittal and coronal surfaces, and to find the regression equation of the inner and outer side of the inner capsule.
Methods: the MRI image data of 30 healthy adult volunteers were derived and preserved in JPG format and then imported into Photoshop software. The images were strictly registered, and the origin of Descartes three-dimensional coordinate system based on the coupling diameter, the X axis and the Y axis were coincided with the software itself, and the inner side of the inner capsule was measured and recorded respectively. The coordinate value X, Y value and Z value of the edge and the outer edge are the product of the layer and thickness of the AC-PC plane at the level of the plane, and the coordinate values of all the sampling points constitute the stereoscopic positioning data set of the inner capsule in the three-dimensional coordinate system; using the data obtained by 30 volunteers, the projection of the transverse, sagittal and coronal surfaces in the SPSS software is completed; The regression equation of the internal capsule in each projection direction was obtained by using the SPSS17.0 software. Results: the stereoscopic positioning data set in the three-dimensional coordinate system of the inner and outer sides of the normal adult male and female inner capsule was constructed, and the projection diagram of the transverse, sagittal and coronal surfaces was drawn, and the regression equation of the inner and outer side of the inner capsule on the projection planes was obtained.
Conclusion: the construction of the stereotaxic data set, the projection of the transverse, the sagittal plane and the coronal plane and the regression equation are drawn and analyzed in the internal capsule, which are based on the joint diameter positioning system, and provide the anatomical basis for the application of stereotactic technology and functional department of Neurosurgery; it also reveals the morphological rules of the occurrence and development of the deep region of the large brain. It is also of great significance.
The third part: the study of the asymmetry of internal capsule
Objective: To observe the presence of sex and lateral asymmetry in the internal capsule.
Methods: using a eFilm workstation in a microcomputer, we selected 30 normal people, 15 men, 15 women, 15 cases and MRI images of the craniocerebral cross section. We selected the internal capsule level and introduced the image into the Photoshop software to measure the distance between the inner capsule area men and the female left and right sides of the median sagittal plane, and the SPSS17.0 software was used to calculate the distance. Men, women on both sides of the distance difference.
Results: the lateral differences and gender differences between the two sides of the internal capsule in male and female were statistically analyzed.
Conclusion: the mapping relationship between the two sides of the inner capsule on both sides of the male and the female can be expressed as a mirror symmetry in the median sagittal face of the two sides of a homosexual group of people, and the male of different sexes is larger than the female.
The fourth part: 3D reconstruction and visualization of the internal capsule of the brain.
Objective: to provide three-dimensional visualization model for the three-dimensional positioning of the inner capsule and adjacent region, the stereotactic radiological orientation, the three-dimensional orientation of the minimally invasive Department of neurosurgery and the teaching of anatomy.
Methods: on the microcomputer, 5 normal adults (without nerve, mental illness history and family history) the scanning data of the 2mm thin layer MRI image of the cerebral transverse fault were introduced into the 3D-Doctor software in the format of Dicom3.0, and the intrications of the inner capsule, the basal nucleus area, the lateral ventricle and the surface of the brain were manually divided, and the different color markers were used for the complex surface reconstruction. Three dimensional reconstruction of the above structures.
Results: the three-dimensional visualization model of the inner capsule, basal nucleus and lateral ventricle in the brain was reconstructed successfully. The model can be rotated in any direction, and the three-dimensional model of the inner capsule, the basal nucleus and the lateral ventricle, the space position in the brain and the position relation of each other in the brain can be reproduced from various angles.
Conclusion: the three-dimensional visualization model of the internal capsule shows the three-dimensional spatial structure and adjacent relationship of the internal capsule in the living brain. It provides an important method for the reconstruction and observation of the occupying lesions in the brain. It is of great value to the formulation of the surgical approach in the stereotactic Department of Neurosurgery, the implementation of the interventional radiology radiotherapy plan and the medical teaching.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2

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