CT仿真内镜成像对鞍区占位术前个体化评价的意义

Significance of CT Virtual Endoscopy Imaging for Individual Preoperative Evaluation of Sellar Lesions

目的探讨CT仿真内镜(CTVE)对不同鞍区肿块经蝶入路解剖结构的显示能力,并与神经内镜比较评价其术前个体化评估价值。资料与方法 35例鞍区肿块患者术前均行蝶鞍区螺旋CT扫描,并行多平面重组和容积再现重建,观察蝶窦入口、蝶窦分隔及鞍底的显示情况。图像质量由2名医师独立评判,分析CTVE对术前蝶鞍区结构的显示率及其相关因素。结果 CTVE图像真实,结果判定一致性较好(Kappa=0.811,P<0.05)。蝶窦入口、蝶窦分隔及鞍底的阳性显示率分别为80.0%、71.4%及77.1%,不同个体的CTVE阳性显示率与术中内镜对照差异无统计学意义(χ2=1.975,P>0.05)。结论 CTVE可以术前清晰地显示蝶窦、鞍底及周围解剖标志的三维图像,直观地显示不同患者手术入路过程中个体化的解剖结构及变异,有利于术前手术方案的制订,提高其安全性。

Purpose To investigate the capability of CT virtual endoscopy （CTVE） for the display of transsphenoidal anatomical landmark of different lesions located in sellar area, and to evaluate its individual value for preoperative assessment compared with neuroendoscopy. Materials and Methods Thirty-five patients with sellar lesions underwent preoperative sella spiral CT volume scan, CTVE images were reconstructed with multi-plane reformation and volume rendering, the display of sphenoid sinus apertura, sphenoid septum and sellar floor was observed. The images were respectively analyzed by two radiologists independently, and the display rate and its related factors for the anatomical structure display of preoperative CTVE were analyzed. Results A good agreement （Kappa=0.811, P〈0.05） was reached for two viewers due to the veridical imaging ofCTVE. The positive detection rate of sphenoid sinus apertura, sphenoid septum and sellar floor were 80.0%, 71.4% and 77.1%, respectively; the positive detection rate of CTVE between different individuals showed no significant difference when compared with intraoperative endoscopy 〈1=1.975, P〉0.05）. Conclusion Three-dimensional images of sphenoid sinus, sellar floor and the surrounding anatomic landmarks can be well depicted by preoperative CTVE, individualized anatomical structures and variations in different patients in the surgical approach can also be visually displayed, which may help to make a precise preoperative planning and increase the safety of the operation.