术前MRI-术中超声融合成像在颅脑肿瘤切除术中的应用

Application of preoperative magnetic resonance and intraoperative ultrasound fusion imaging in the resection of brain tumors:a pilot study

目的初步探讨术前MRI-术中超声融合成像(融合成像)在颅脑肿瘤手术中的可行性和应用价值。方法纳入诊断为颅脑肿瘤并拟行手术切除的18例患者(20个病灶),使用融合成像导航系统进行定位,观察病灶的术中超声显示情况及融合成像的定位效果,根据术后72 h内增强MRI结果判断切除效果,观察术后并发症。结果 20个病灶中,10个(50%)在超声图像上边界显示良好(边界清晰);8个(40%)在超声图像显示中等(部分边界显示不清),其中6个(30%)通过融合成像提高了定位效果(边界识别清晰);2个(10%)病灶超声图像显示不好(边界不清)而无法定位,通过融合成像实现了快速定位。术后MRI结果显示18个(90%)病灶为完全切除,2个(10%)病灶为大部分切除。术后未出现严重的手术相关并发症。结论融合成像能提高颅脑肿瘤手术术中肿瘤的定位效果,且安全、有效。

Objective To investigate the feasibility and application value of preoperative magnetic resonance(MRI)combined with intraoperative ultrasound fusion imaging in brain tumor resection.Methods Eighteen patients(20 lesions)who were diagnosed with brain tumors and scheduled to undergo the resection surgery were recruited in this investigation.Preoperative MRI and intraoperative ultrasound fusion imaging system was used for locating the tumors and guiding the resection.The quality of intraoperative ultrasound image and the tumor locating effect of the fusion imaging were observed and evaluated.The resection effect was assessed according to enhanced MRI within postoperative 72 h.The incidence of postoperative complications was observed.Results Ten of 20 lesions(50%)showed well-defined tumor margins(clear margins)on intraoperative ultrasound image,8 lesions(40%)were moderately-defined(partially ill-defined margins).The locating effect was enhanced(clear margins)by MRI and ultrasound fusion imaging in 6 lesions(30%),and 2 lesions(10%)appeared as ill-defined(unclear margins),which could be rapidly located by MRI and ultrasound fusion imaging system.Postoperative MRI demonstrated 18 lesions(90%)were completely resected and 2 lesions(10%)were confirmed as partial resection.No severe adverse events occurred after surgery.Conclusion Preoperative MRI combined with intraoperative ultrasound fusion imaging can enhance the accuracy of locating the brain tumors,which is a safe and efficacious approach applied in the resection of brain tumors.