3.0 T MR ESWAN与T_(2)像在帕金森病DBS术前靶点规划中作用比较

Comparison of 3.0 T MR ESWAN and T_(2)WI in preoperative target planning of DBS in Parkinson's disease

目的探讨3.0 T MR ESWAN与T_(2)像显示的丘脑底核(STN)边界与微电极记录(MER)确定的边界在DBS术前规划中的价值。方法20例拟行丘脑底核脑深部电刺激术(STN-DBS)治疗的原发性帕金森病患者,均行术前3.0 T MR 3D T_(1)、T_(2)及ESWAN扫描,将其融合后做术前规划设计靶点及针道。分别比较T_(2)及ESWAN规划的背外侧界与MER的符合率;ESWAN规划的腹内侧界与MER的符合率。结果T_(2)像能很好地显示STN背外侧界,与MER符合率达85.4%。ESWAN序列能很好地显示STN腹内侧,且与黑质有明确的分界,与MER符合率高达95.2%。结论3.0 T MR ESWAN与T_(2)结合能提高STN-DBS术前靶点规划的精确性。术中结合MER及宏刺激结果可修正术前计划的不足,使最终植入的靶点更加合理。

Objective To explore the value between the boundary of subthalamic nucleus(STN)on 3.0 T MR ESWAN and T_(2)WI with that determined by microelectrode recording(MER)in preoperative planning of deep brain stimulation(DBS).Methods 20 patients with primary Parkinson's disease undergoing subthalamic nucleus deep brain stimulation(STN-DBS)were scanned with 3.0 T MR 3D T_(1)WI,T_(2)WI and ESWAN before operation.The target and needle path were designed before operation.The coincidence rate between the upper outer boundary of T_(2)WI and ESWAN planning and the MER were compared.The coincidence rate between the lower inner boundary of ESWAN planning and the MER were compared.Results T_(2)WI could well show the lateral boundary of STN,and the coincidence rate with MER was 85.4%.ESWAN sequence could well display the boundary between the ventromedial STN and substantia nigra,and the coincidence rate with MER was as high as 95.2%.Conclusion 3.0 T MR ESWAN combined with T_(2)WI can improve the accuracy of preoperative target planning for STN-DBS.The combination of intraoperative MER and macro stimulation results can correct the lack of preoperative planning and make the final target more reasonable.