三维影像导航引导肝肿瘤消融的基础与临床研究

发布时间：2018-11-14 19:07

【摘要】：影像引导消融治疗是治疗实体肿瘤的有效方法。传统的二维影像引导虽然获得了显著成果，但尚有诸多不足。三维影像导航的出现能够推动影像引导消融治疗达到新高度。因此，本论文提出了术中三维影像导航，并对三维影像导航的关键技术进行了基础和临床研究,成功的将三维影像导航技术应用于临床，并取得满意的疗效。本论文主要工作如下： 1.超声探头标定的基础研究。成功的建立了通过自制“N”型线框模板精准标定超声探头的方法，获取探头标定位移参数Tx、Ty、Tz和旋转参数Rα、Rβ、Rγ；并通过自制刚体模型1号验证了该标定方法具有较高的精准度，为在三维影像上实时显示超声探头扫查切面即实时三维影像导航奠定了基础。 2.三维导航技术的基础研究。成功将微波消融针针尖标定至三维影像内，，可实时显示微波消融针虚拟图像，并通过自制刚体模型2号验证了三维导航平均误差约0.52mm±0.389，应用CIRS标准模拟腹部穿刺体模验证了三维导航引导穿刺8～14mm模拟病灶准确性为91.43%，为三维影像导航技术的临床应用奠定基础。 3.图像配准融合的临床研究。应用配对设计的临床实验比较体内定标法和体表定标法配准融合误差。实验对象为临床患者的肝肿瘤病灶，融合图像为超声与CT。体表定标法配准融合平均误差8.9mm±4.15，体内定标法配准融合平均误差7.58mm±3.88，P＜0.05；体表定标法配准融合平均时间195s±43.55，体内定标法配准融合平均时间457.62s±290.81，P＜0.05。本研究为三维导航技术中的配准融合方法的选择提供了依据。 4.三维影像导航引导消融治疗的临床研究。第一节，应用三维影像导航技术引导消融治疗常规超声显示不清或显示不完全的原发性肝癌病灶，成功对13例患者15个结节进行了消融治疗，疗效满意，一次治疗成功率80%，局部进展率7.1%，三维影像导航技术用于治疗常规超声显示不清或显示不完全的原发性肝癌可行、安全、有效。第二节设计了前瞻性非随机对照队列研究，对比三维影像导航和传统二维超声引导微波消融原发性肝癌的空间布针效果，三维导航组一次治疗成功率8.3%，二维超声组37.%，P＜0.05；三维导航组平均布针时间300.5s±46.53，二维超声组521.04s±143.91，P＜0.05；三维影像导航能够提高肝肿瘤消融空间布针的有效性并缩短平均布针时间。结论：三维影像导航技术精度高、立体空间信息丰富，用于引导微波消融治疗肝癌可行、安全、有效，并且能够提高肝癌消融空间布针的有效性，缩短平均布针时间。
[Abstract]:Image-guided ablation is an effective method for the treatment of solid tumors. Although the traditional two-dimensional image guidance has achieved remarkable results, there are still many shortcomings. The appearance of three-dimensional image navigation can promote the treatment of image-guided ablation to a new level. Therefore, in this paper, 3D image navigation is put forward, and the key technology of 3D image navigation is studied in the foundation and clinic. The 3D image navigation technology is successfully applied in clinic, and the curative effect is satisfactory. The main work of this paper is as follows: 1. The basic Research of Ultrasonic probe Calibration. The method of accurately calibrating ultrasonic probe by self-made "N" shape wire frame template is established successfully, and the calibration displacement parameters Tx,Ty,Tz and rotation parameters R 伪, R 尾, R 纬 of the probe are obtained. The accuracy of the calibration method is verified by self-made rigid body model No. 1, which lays a foundation for the real-time display of ultrasonic probe scanning and tangent plane on 3D image, that is, real-time 3D image navigation. 2. The basic research of three-dimensional navigation technology. The microwave ablation needle tip was successfully calibrated into 3D image, and the virtual image of microwave ablation needle could be displayed in real time. The mean error of three-dimensional navigation was verified by self-made rigid body model No. 2, which was about 0.52mm 卤0.389. The accuracy of three-dimensional navigation guided puncture 8~14mm simulation was 91.43, which laid a foundation for the clinical application of three-dimensional image navigation technology. 3. Clinical study of image registration fusion. In-vivo calibration method and body surface calibration method were used to compare the registration and fusion errors. The experimental object was the focus of liver tumor in clinical patients, and the fusion images were ultrasound and CT.. The average error of body surface calibration was 8.9mm 卤4.15, and that of in vivo calibration was 7.58mm 卤3.88 (P < 0.05). The mean fusion time of body surface calibration method was 195s 卤43.55, and that of body surface calibration method was 457.62s 卤290.81g (P < 0.05). This study provides a basis for the selection of registration and fusion methods in three-dimensional navigation technology. 4. Clinical study of three-dimensional Image Navigation guided Ablation Therapy. In the first section, three dimensional image navigation technique was used to guide ablation in the treatment of primary liver cancer with conventional ultrasound. Thirteen patients with 15 nodules were successfully treated with ablation. The success rate of one treatment was 80%. The local progression rate is 7.1%. Three-dimensional imaging navigation technique is feasible, safe and effective in the treatment of primary liver cancer with conventional ultrasound. In the second section, a prospective non-randomized controlled cohort study was designed to compare the effects of three-dimensional image navigation and conventional two-dimensional ultrasound guided microwave ablation of primary liver cancer with spatial needle placement. The success rate of one treatment in the three-dimensional navigation group was 8.3%. In the two dimensional ultrasound group, the ratio of 37. 0% and 37%, P < 0. 05; The mean needling time of three-dimensional navigation group was 300.5s 卤46.53, and that of two-dimensional ultrasound group was 521.04s 卤143.91 (P < 0.05). Conclusion: the three-dimensional image navigation technology has high accuracy and rich three-dimensional spatial information. It is feasible, safe and effective to guide microwave ablation for the treatment of liver cancer. It can also improve the effectiveness of space needle placement and shorten the average needle placement time.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R735.7;R445.1

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