运用Slicer 3D重建技术实现三叉神经痛神经血管关系术前可视化

Presurgical Visualization of the Neurovascular Relationship in Trigeminal Neuralgia with 3D Modeling Using Free Slicer Software

目的探讨Slicer软件和3D重建技术在术前明确三叉神经痛(TN)患者的神经血管关系(NVR)中是否比稳态捕获快速MRI成像(MRI FIESTA)具有更高的准确性。方法研究纳入40例行术前MRI FIESTA和显微血管减压术(MVD)患者。术前使用3D Slicer软件重建和MRI分别确定神经血管关系和责任血管,结果与术中发现进行比较。结果在明确NVR方面,MRI FIESTA与术中发现的一致性(kappa值k=0.232),而3D重建与术中发现一致性(k=0.633)。两种方法一致性无显著差别(c2=8.09,P=0.088)。在明确责任血管方面,MRI FIESTA与术中发现的一致性(k=0.373),而3D重建与术中发现的一致性(k=0.922),两种方法一致性有显著差异(c2=82.01,P=0.000)。在明确NVR方面,MRI FIESTA的敏感性与特异性分别为87.2%和100%;3D重建的敏感性与特异性均为100%。结论在术前明确NVR和责任血管中,3D重建技术比MRI FIESTA具有更高的准确性。3D重建技术与术中发现一致,对术前决策和制定手术计划更有帮助。

Objective To explore whether segmentation and3D modeling are more accurate in the preoperative detection of the neurovascular relationship(NVR)in patients with trigeminal neuralgia(TN)compared to MRI fast imaging employing steady-state acquisition(FIESTA).Methods Segmentation and3D modeling using3D Slicer were conducted for40patients undergoing MRI FIESTA and microsurgical vascular decompression(MVD).Results The NVR,as well as the offending vessel determined by MRI FIESTA and3D Slicer,was reviewed and compared with intraoperative manifestations using SPSS.The k agreement between the MRI FIESTA and operation in determining the NVR was0.232and that between the3D modeling and operation was0.6333.There was no significant difference between these two procedures(c2=8.09,P=0.088).The k agreement between the MRI FIESTA and operation in determining the offending vessel was0.373,and that between the3D modeling and operation was0.922.There were significant differences between two of them(c2=82.01,P=0.000).The sensitivity and specificity for MRI FIESTA in determining the NVR were87.2%and100%,respectively,and for3D modeling were both100%.Conclusion The segmentation and3D modeling were more accurate than MRI FIESTA in preoperative verification of the NVR and offending vessel.This was in consistent with surgical manifestations and was more helpful for preoperative decision and surgical plan.