基于1H-MRS脑胶质瘤影像病理分区及三维可视化模型构建的方法学研究

Based on 1H-MRS gliomas and brain tissue surrounding district and three-dimensional visualization model constructe

目的:研究氢质子磁共振波谱分析(1H-MRS)在脑胶质瘤及周边脑组织的病理分区、边界分割及组织差异化的三维重建方法。方法:选取5例拟诊为脑胶质瘤的患者,术前先行T1WI、T2WI及增强扫描,增强后行1H-MRS检查、分析,并与术后病理结果进行对照,根据多种代谢产物水平对胶质瘤进行分级及胶质瘤与周边脑组织分区。选取1例胶质瘤扫描数据以Dicom3.0格式导入3D-Doctor软件,人工分割肿瘤区、坏死区、水肿区、大脑表面,分别以不同颜色标示,以复杂面重建方法对上述结构同时进行三维重建。结果:利用1H-MRS对胶质瘤的肿瘤区及周边区域进行了大体分区,并且于术前对肿瘤进行的良恶性分级与术后病理结果相符。成功重建了肿瘤区及周边脑组织在整脑中的三维可视化模型,模型可以任意方位旋转,从不同角度再现了肿瘤的三维形态及在大脑中的空间位置,以及它们之间的相互位置关系。结论:脑胶质瘤采用1H-MRS的Cho/Cr、NAA/Cr、NAA/Cho代谢物比值结合常规MRI对胶质瘤诊断及对胶质瘤进行无创性分级、分区是可行的。胶质瘤的三维可视化模型的构建,展现了肿瘤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。对立体定向外科制定手术入路、介入放射制定放疗计划及医学教学都有很大的应用价值。

Objective： To investigate the methodology of pathological partition, boundary segmentation, 3D-reconstruction and visualization with multi-voxel proton MR spectroscopy （ l H-MRS ） in human brain gliomas for clinical application. Methods： Five patients with brain gliomas underwent T1WI, T2WI, contrast enhanced MRI and 1H-MRS before the operation. And the results were compared with pathological results, according to a variety of metabolites levels grade gliomas and part glioma and surrounding brain tissue. Select one case of glioma scanned data of Dicom3.0 format import 3D-Doctor software, artificial divide tumor area, necrosis, edema,brain surface, were marked with different colors, in complex surface reconstruction method three-dimensional reconstructe structure of the above simultaneously. Results：Using 1H-MRS for glioma tumor and surrounding area were largely partitioned and in preoperative classification of benign and malignant tumors were consistent with pathological results. Successful reconstructe of the tumor and surrounding brain tissue three-dimensional visualization model of the entire brain, could be rotated in any orientation, the model from different angles reproduce the three-dimensional shape and spatial location of the tumor in the brain and the positional relationship. Conclusions： Brain tumors using 1H-MRS of Cho/Cr, NAA/Cr, NAA/Cho metabolite ratios in combination with conventional MRI in the diagnosis of brain tumors and non-invasive glioma grade and part is feasible. The gliomas three-dimensional visualization model reconstruction, the model from different angles reproduce the three-dimensional shape and spatial location of thetumor in the brain and the positional relationship, for reconstruction and observation of brain lesions provides an important approach. Surgical approach to the development of stereotactic surgery, interventional radiology and radiation treatment planning to develop medical education has great Value.