基于弥散张量成像的纤维束追踪技术重建面神经的研究

发布时间：2018-09-13 07:38

【摘要】：目的：探讨听神经瘤患者术前应用基于弥散张量成像的纤维束追踪技术进行面神经重建，以观察面神经与肿瘤相对位置关系的可行性和准确性。方法：选取2012年11月～2013年7月在解放军总医院神经外科就诊的病例。入组标准：病变位于桥脑小脑角区，初步诊断为听神经瘤，并在我科进行手术治疗。排除标准：有颅内手术史、放射治疗史，术后病理证实为非神经鞘瘤。共15例患者入组，术前使用3.0T磁共振仪采集常规的T1WI、T2WI和增强序列，以及三维循环相位稳态采集快速成像（3D FIESTA-C）和弥散张量成像（DTI）序列的数据。使用3D Slicer软件进行基于弥散张量成像的纤维束追踪，根据3DFIESTA-C图像精确选取患侧内听道和面神经出脑干端这两个区域作为感兴趣区（ROI），追踪同时通过这两个ROI区的神经纤维束，并对肿瘤和追踪出来的面神经进行三维重建，获知面神经的走行及其与肿瘤的相对位置关系。脑池段面神经与肿瘤的位置关系分为腹侧上方、腹侧中央、腹侧下方、肿瘤上极、肿瘤下极及背侧6种。通过手术中观察到的实际情况验证追踪重建出的面神经位置及走行的准确性。结果：入组的15例患者中，14例患者利用基于弥散张量成像的纤维束追踪技术重建出面神经，可直观地观察到面神经的走行以及和肿瘤的相对位置关系，1例患者未重建出完整的同时通过两个ROI区的神经纤维束走行。经过与术中观察对比验证，其中13例患者的面神经重建结果与实际位置相一致，这些患者的面神经均位于肿瘤的腹侧，其中腹侧上方7例，腹侧中央1例，腹侧下方3例，肿瘤下极2例。结论：对于听神经瘤患者，术前应用基于弥散张量成像的纤维束追踪技术重建面神经存在一定的可行性，有助于术者在术前直观的观察到面神经与肿瘤的位置及走行，对于术中有目的地寻找面神经、减少神经损伤、加快手术切除速度都能带来良好的受益，但该技术对面神经的重建还存在一定的局限性和不确定性，，其准确性还有待进一步的验证。
[Abstract]:Objective: to investigate the feasibility and accuracy of facial nerve reconstruction in patients with acoustic neuroma by using the technique of traceability based on diffusive Zhang Liang imaging before operation to observe the relative position of facial nerve and tumor. Methods: from November, 2012 to July, 2013, the patients in the department of neurosurgery of PLA General Hospital were selected. Admission criteria: the lesion was located in the cerebellopontine angle area and was initially diagnosed as acoustic neuroma and operated in our department. Exclusion criteria: history of intracranial surgery, radiotherapy, postoperative pathology confirmed as non-neurilemmoma. A total of 15 patients were enrolled in the study. Routine T _ 1WI T _ 2WI and enhancement sequences were collected by using 3.0T MRI before operation, and the data of 3D circulating phase steady-state imaging (3D FIESTA-C) and diffusion-Zhang Liang (DTI) sequences were collected. Using 3D Slicer software to track the fiber bundle based on diffusion-Zhang Liang imaging. According to the 3DFIESTA-C image, the two regions of auditory canal and the brainstem of facial nerve were selected accurately as the region of interest (ROI), tracing the nerve fiber bundles passing through the two ROI regions at the same time. The three dimensional reconstruction of the tumor and the tracing facial nerve was carried out to find out the course of the facial nerve and the relative position between the tumor and the tumor. The relationship between the location of facial nerve in cisternal segment and tumor can be divided into 6 types: superior ventral, ventral central, inferior ventral, superior, inferior and dorsal. The accuracy of tracking the reconstructed facial nerve was verified by the actual situation observed during the operation. Results: the facial nerve was reconstructed in 14 of the 15 patients by using the fiber bundle tracing technique based on diffusive Zhang Liang imaging. It was observed intuitively that the movement of the facial nerve and its relation to the relative position of the tumor in one patient had not been reconstructed completely and the nerve fiber bundles in two ROI regions were passing along at the same time. The results of facial nerve reconstruction in 13 patients were consistent with the actual position. The facial nerves of these patients were located in the ventral side of the tumor, including 7 cases above the ventral side, 1 case at the ventral center and 3 cases below the ventral side. There were 2 cases of tumor lower pole. Conclusion: for the patients with acoustic neuroma, it is feasible to reconstruct the facial nerve by using the fiber bundle tracing technique based on diffusive Zhang Liang imaging, which is helpful to observe the position and the course of facial nerve and tumor before operation. In order to find the facial nerve purposefully, reduce the nerve injury and speed up the surgical resection, it can bring good benefits, but the technique has some limitations and uncertainties for the reconstruction of the facial nerve. Its accuracy needs further verification.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R739.4

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