三叉神经半月神经节MRI成像方法及测量

目的：提供在三维方向上清晰显示半月神经节的MRI成像方法。方法：对10例临床明确诊断并排除颅内占位的三叉神经痛患者的20侧半月神经节区进行增强T1加权像的快速自旋回波（FSET1）、T2加权像的快速自旋回波（FRFSET2）、三维时间飞越法血管造影（3D-TOF）、三维快速静-动稳态采集序列（3DFiesta）4种序列的MRI扫描,由2名放射科医师读片、测量,并利用SurgView-RFT电磁导航系统分割半月神经节（TGG）。采用SAS6.12软件包对数据进行t检验和KruskalWallis检验。结果：不同序列间存在显著差异,边缘清晰度依次为增强FRFSET2、增强3-DFiesta、增强3-DTOF、增强FSET1,内部清晰度依次为增强3-DFiesta、增强FRFSET2、增强3-DTOF、增强FSET1。在增强FRFSET2轴向位上测得的TGG大小为长度平均值20.5mm,宽度平均值9.3mm,厚度平均值12.5mm;在增强3-DFiesta轴向位上测得的TGG大小为长度平均值20.45mm,宽度平均值9.45mm,厚度平均值11.65mm,两者无显著差异。图像分割成功率增强FSET1为0,增强FRFSET2为85%（17/20）,增强3-DTOF为60%（12/20）,增强3-DFiesta为90%（18/20）。增强3-DFiesta与增强FSET1、增强3-DTOF有显著差异,增强FRFSET2与增强3-DFiesta无显著差异。结论：TGG的MRI最佳显示方法为增强3-DFiesta,为导航辅助射频温控热凝术过程中TGG的图像分割和CT/MRI配准奠定基础,也为临床开展三叉神经痛TGG水平的X刀或γ刀治疗提供影像学上的指示。     

融合CT和MRI数据构建颌面部3D数字化模型

目的 探索通过精确、高效配准CT和MRI数据,建立包含颌面部主要肌肉和骨骼组织的3D数字化模型.方法 对1名志愿者行颌面部螺旋CT及MRI扫描,数据分别导入Mimics 15.0中,在3个视窗,即横断面、矢状面、冠状面,分别调整两种数据至同一断层,以树脂球为配准点,至少5个点配准两组数据.再利用CT分割并重建颌骨和面部皮肤3D模型,利用MRI分割重建面部主要肌肉3D模型.结果 建立了包含3对咀嚼肌、12对表情肌、面部皮肤与颌骨组织的3D模型,配准模型具有较高的一致性和相对位置精度.结论实现了CT与MRI两种影像学数据的配准融合.     

实时CT引导下的经皮半月神经节射频热凝术

目的：针对半月神经节的阻滞是治疗三叉神经痛的有效措施，但传统X线不能清楚的将颅底卵圆孔显示清楚，将大大影响手术的成功率。本研究介绍一种新的方法，就是通过高速实时CT透视检查成像引导穿刺针的穿刺位置，该方法将卵圆孔显示清楚，因此大大提升手术的成功率。方法：本研究收录15位三叉神经痛的患者，应用高速实时CT透视检查引导穿刺针定位，实行经皮半月神经节射频热凝术。结果：所有患者（15位）经过治疗后三叉神经痛的症状都得到明显改善，并且没有严重并发症发生。仅有一例患者出现了中度的感觉异常。结论：所有患者（15位）经过治疗后三叉神经痛的症状都得到明显改善，并且没有严重并发症发生。仅有一例患者出现了中度的感觉异常。     

CT三维重建引导下经颌下入路精确穿刺卵圆孔外口射频热凝治疗三叉神经痛研究

目的：CT三维重建引导下经颌下入路的改良式穿刺卵圆孔行半月神经节射频温控热凝术治疗三叉神经痛.并对其操作方法及疗效进行分析.方法：对20例原发性三叉神经痛患者经颌下入路方式行半月神经节射频温控热凝术治疗.结果：术后疼痛即刻消失18例,2例经服用小剂量卡马西平3～7 d疼痛消失,术后1个月内有1例复发,有效率95％,1年后随访,无复发病例.结论：CT三维重建引导下,经颌下入路穿刺卵圆孔的方法具有有效性及可行性,避免了因颅底结构的特殊性及传统入路方式角度的局限性而使热凝探针无法到达卵圆孔内,致使手术失败.     

CT和MRI图像融合三维重建颞下颌关节的研究

目的利用CT和MRI扫描图像,探讨采用模型融合技术对颞下颌关节（TMJ）软硬组织进行三维重建的方法,为TMJ生物力学研究及其临床分析提供依据。方法选择1例健康青年男性志愿者,在其双侧TMJ区和颏部共放置12个人造球形标记,经CT和MRI扫描,获取含有所有球形标记的TMJ医学图像,分别采用CT和MRI两套数据建立TMJ软硬组织的三维几何模型。基于人造球形标记在三维空间上配准,对TMJ软硬组织进行三维重建。结果建立了具有良好几何相似性的TMJ三维几何模型,包括关节盘、关节窝、下颌骨和下牙列。TMJ三维几何模型的建立方法简便快捷,模型逼真,解剖结构清楚,能较真实地反映TMJ各结构的空间位置关系。结论利用CT和MRI医学图像融合技术,基于人造球形标记的配准过程进行TMJ三维重建,所建立的模型具有良好的几何相似性。在三维水平上进行图像的融合,具有定位精确,配准过程简单等特点,能真实、合理地对TMJ软硬组织进行三维重建。     

基于增强现实的下颌角截骨配准技术的研究

目的:通过增强现实技术,将下颌骨的虚拟三维数字模型及术前设计的预截骨平面同时显示在快速成型实体模型上,实现虚拟图像与实体的重叠配准.方法:选取20例下颌骨肥大患者,行三维CT扫描,重建下颌骨三维数字模型.利用上海九院整形设计系统完成术前设计,生成截骨平面,并与下颌骨合并为STL文件.取患者下牙石膏牙模,制作包含下牙咬合板在内的标志物支架,固定于石膏牙模,两者一并扫描.然后将扫描数据和下颌骨三维数字模型数据导入同一三维处理平台,选择右第一磨牙的远中舌尖、第二磨牙的近中舌尖、左第一磨牙的近中舌尖,进行标志物支架和下颌骨的拟合,生成虚拟影像.此时的三维虚拟数字化影像包括标志物、下颌骨及预截骨平面.然后将标志物支架的下牙咬合板固定于下颌骨快速成型模型上,采用增强现实视频检测方法.用视频捕捉器识别到标志物后,将虚拟影像与下颌骨快速成型实体模型进行配准.结果:该技术实现了三维虚拟数字化影像与下颌骨快速成型模型的虚实融合叠加,使下颌骨和术前设计的预截骨平面实时显示在下颌骨实体上.结论:本研究建立的配准方法具有良好的重复性,有望成为下颌角截骨术可视化手术有效的配准途径,为未来增强现实手术应用研究奠定了基础.     

配准标记点外形对三维图像配准精度影响研究

目的    探讨配准标记点外形差异对三维图像配准精度的影响。方法    分别采用4种不同外形的配准标记点,配准试样锥形束CT（CBCT）三维图像与其原始设计三维图像,而后通过测量配准后试样的2种三维图像间的距离差,来分析不同外形配准标记点对三维图像配准精度的影响。结果    配准偏差分别为立方形（0.0938 ± 0.0062）mm、球形（0.0854 ± 0.0056）mm、圆柱形（0.1032 ± 0.0061）mm、圆台形（0.0972 ± 0.0062）mm,仅球形配准标记点组与其他组间的差异有统计学意义（P < 0.05）。结论    实验中所选的几种配准标记点均可较好地实现三维图像配准,相比较而言,球形配准标记点具有更高的配准精度。     

2种不同形变配准软件在头颈部勾画中的作用评价

目的 比较2种目前放疗市场上主流的形变配准软件在CT形变配准中的结果表现,确定其在图像配准中的价值。方法 选择本院2018年2月—2020年6月收治的15例重复定位的头颈部肿瘤患者作为研究对象,治疗过程中前、后2组CT图像正常组织由同一位资深医师进行勾画,分别在MIM软件和AccuContour软件中进行形变配准,将第一组图像的正常组织形变到第二组图像中,与第二组图像直接勾画的组织进行计算,得到相似性系数（Dice系数）与空间评价指标（Hausdorff距离）。采用SPSS 23.0软件包对数据进行统计学分析。结果 2种形变配准软件都有良好的形变配准功能。正常组织显像不同,对配准结果有一定影响,眼球、下颌骨等显像良好的组织配准结果更好,晶体、视神经、视交叉等小体积组织配准结果较差。2组软件相比,MIM软件更具有优势;Dice系数评价中,MIM软件数据更佳的比率为67%,其中55%存在统计学意义（P<0.05）;Hausdorff距离显示,MIM软件数据更佳的比率为74%,其中48%的指标存在统计学意义（P<0.05）。结论 2种形变配准软件都具备良好的形变配准能力,相对而言,MIM软件更有优势。对形变配准精度要求较高时,选择MIM软件更佳。     

无牙颌印模不同配准方法的对比研究

目的:比较无牙颌印模两种配准方法配准结果的准确性,探讨适合无牙颌印模的配准方法。方法:全口或半口牙列缺失要求传统全口义齿修复的患者,以开口与闭口两种方式取模,获得上颌模型12组,下颌模型10组,模型扫描仪扫描,STL格式保存。逆向工程软件分别使用最佳拟合对齐与手工多点+全局配准两种方法对开口式与闭口式印模进行配准,三维偏差分析。SPSS17.0,配对t检验,显著性标准双侧α=0.05。结果:偏差名义值阈值区间面积最佳拟合对齐组(上颌48.58%,下颌44.16%)<手工+全局配准组(上颌70.55%,下颌66.27%),上颌P=0.000,下颌P=0.014,差异有统计学意义。上下颌RMS(root mean square)、平均正、负偏差最佳拟合对齐组>手工+全局配准组,差异上颌有统计学意义,下颌无统计学意义。结论:无牙颌印模的配准,手工多点联合全局配准方法优于最佳拟合对齐方式,在上颌表现更突出。     

三维CT引导下经卵圆孔穿刺射频治疗三叉神经痛

目的:探讨三维CT引导下经卵圆孔穿刺射频治疗三叉神经痛的临床疗效。方法:随机选取我院2013—2015年收治的三叉神经痛患者38例,行三维CT引导卵圆孔穿刺射频术治疗,对其临床疗效和术后并发症进行分析,并进行6个月的随访。结果:38例患者行三维CT引导卵圆孔穿刺射频治疗三叉神经痛手术均成功。术后第1天有效率达78.95%,12例患者完全缓解,有1例未缓解。术后1个月与术后6个月的有效率分别为94.74%和97.37%,二者之间差异不具有统计学意义(P>0.05),且均显著高于术后第1天和第7天,差异均具有统计学意义(P<0.05)。结论:三维CT引导下经卵圆孔穿刺射频治疗三叉神经痛可提高穿刺成功率,减少并发症,选择性毁损痛觉纤维有助于提高患者生活质量,值得临床推广使用。     

三维CT在颅底影像诊断中的应用

目的　探索三维 Ｃ Ｔ 成像在颅底中的应用价值。方法　对２５ 个病例的颅底行 Ｃ Ｔ横断扫描,采用表面阴影显示（ Ｓ Ｓ Ｄ）法进行颅底骨三维重建,分析病变引起颅底骨质改变在三维重建图像上的表现。结果　４ 例颅底骨折的三维重建提供了更多的骨折征象。１５ 例颅底病变术前或术后三维重建为手术方案制定、术后评价、随访及进一步治疗提供了客观真实的立体参考资料。６ 例三叉神经痛射频治疗过程中三维重建有利于制定更安全可靠的穿刺进针线路。结论　在二维 Ｃ Ｔ 基础上的三维成像对检查解剖结构复杂而不规则的颅底是非常有意义的 。     

Diagnosis and surgical outcomes of intraparotid facial nerve schwannoma showing normal facial nerve function

The findings of intraparotid facial nerve schwannoma (FNS) using preoperative diagnostic tools, including ultrasonography (US)-guided fine needle aspiration biopsy, computed tomography (CT) scan, and magnetic resonance imaging (MRI), were analyzed to determine if there are any useful findings that might suggest the presence of a lesion. Treatment guidelines are suggested. The medical records of 15 patients who were diagnosed with an intraparotid FNS were retrospectively analyzed. US and CT scans provide clinicians with only limited information; gadolinium enhanced T1-weighted images from MRI provide more specific findings. Tumors could be removed successfully with surgical exploration, preserving facial nerve function at the same time. Gadolinium-enhanced T1-weighted MRI showed more characteristic findings for the diagnosis of intraparotid FNS. Intraparotid FNS without facial palsy can be diagnosed with MRI preoperatively, and surgical exploration is a suitable treatment modality which can remove the tumor and preserve facial nerve function.     

口腔颌面部肌间血管瘤不同病理分型的影像学表现

目的 ：探讨口腔颌面部高血循肌间血管瘤（IMH）的CT、MRI（包括磁共振动态增强）的表现特征与病理分型的关系。方法 ：回顾分析2001—2013年间18例经病理检查证实的口腔颌面部IMH患者的术前影像学资料。其中男3例,女15例,年龄5~57岁,平均年龄33.4岁。结果 ：CT、MR图像显示,6例患者累及多块肌肉,12例累及单块肌肉。好发于咬肌（6例）及舌体（6例）。3例患者影像学表现为高血循病变,磁共振动态增强的SI-time曲线为Ⅱ型：早期快速强化后出现平台期,病理分型为毛细血管型2例、混合型1例。15例患者影像学表现为低血循病变,SI-time曲线为Ⅰ型,病理分型为海绵血管型。4例发现静脉石。结论 ：IMH的 CT、MR影像学表现及其SI-time曲线分型,能进一步帮助诊断其病理分型。     

A novel technique of delivering viral vectors to trigeminal ganglia in rats

The objective of this study was to develop a viable and reliable technique of delivering viral vectors to rat trigeminal ganglia. Adult Sprague‐Dawley rats (200–300 g) were used, and lentiviral vectors containing enhanced green fluorescence protein and calcitonin gene‐related peptide short hairpin RNA (shRNA) were generated. Following general anesthesia, viral vectors were delivered to rat trigeminal ganglia using the technique described in this study. Both X‐ray and micro‐computed tomography (micro‐CT) were employed to verify the position of the needles when injecting the vectors. In vivo fluorescence imaging and immunostaining against enhanced green fluorescence protein were performed to determine the success of viral transduction.The levels of calcitonin gene‐related peptide in trigeminal ganglia were determined using real‐time PCR, and pain levels following injections were evaluated using the Rat Grimace Scale. Our results show that injection needles can be advanced precisely at the trigeminal fossa and that viral vectors can successfully transduce trigeminal ganglia. Moreover, the levels of calcitonin gene‐related peptide at trigeminal ganglia were down‐regulated on day 7 after viral transduction. Pain levels returned to baseline by day 7 following injection. Therefore, we suggest that our trigeminal ganglion‐targeting technique could be used for delivering genes or drugs to rat trigeminal ganglia.     

In-line (18)F-fluorodeoxyglucose positron emission tomography with computed tomography (PET/CT) in patients with carcinoma of the sinus/nasal area and orbit.

BACKGROUND: Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are the standard imaging techniques to evaluate patients with carcinoma in the sinus/nasal area and orbit. The use of positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) in such patients is as yet less well established. PURPOSE: The aim of this study was to assess the clinical impact of PET co-registered with CT (PET/CT). PATIENTS: Evaluation of 21 consecutive patients. METHODS: A retrospective analysis of the whole body PET/CT studies was done. Images were assessed visually without knowing the results of the other imaging technique. Histology and clinical follow-up served to verify lesions. The clinical impact on therapy was assessed together with the physician in charge. RESULTS: All patients underwent PET/CT and CT or MRI for staging (n=9 scans) and restaging (n=17 scans) without treatment between the examinations. PET/CT changed the treatment protocol in 2 patients at staging and in 7 at re-staging. Distant metastases were found in 5 and a secondary tumour in 1 patient. CONCLUSIONS: Whole body PET/CT adds clinically important information to CT or MRI, thus, influencing treatment.     

Detection of the apical lesion and the mandibular canal in conventional radiography and computed tomography

OBJECTIVE: The purpose of this study was to compare the information gathered from dental radiography and high resolution computed tomography (CT) scans with regard to the detection of the endodontic lesion and its relation to the important neighboring anatomic structures such as the mandibular canal. STUDY DESIGN: Fifty patients with a persistent apical lesion referred for endodontic surgery were selected. The teeth involved were 6 mandibular premolars and 44 mandibular molars. Eighty roots were evaluated. For each case 1 CT scan and 1 periapical radiograph were taken. The apical lesion and the mandibular canal were evaluated for possible identification in CT scan or radiograph. The presence of the lesion was correlated to the findings during the surgical procedure. The CT scans of the involved roots were further evaluated with regard to the bone thickness and differentiation between cancellous and cortical bone. The position of the lesion/root within the mandible was studied in all dimensions. RESULTS: All 78 lesions diagnosed during surgery were also visible with the CT scan. In contrast, only 61 of the lesions were noted by conventional radiographs. The mandibular canal could be identified in 31 cases in dental radiographs, whereas in the oblique cuts of the corresponding CT scans the mandibular canal was detected in all patients. The amount of cortical and cancellous bone and the bone thickness as well as the three-dimensional extent of the lesion could only be adequately interpreted in CT scans. CONCLUSIONS: The use of CT provides additional, beneficial information not available from dental radiographs for treatment planning in apical surgery of mandibular premolars and molars. When the mandibular canal cannot be detected in dental radiographs or is in close proximity to the lesion or root apex, CT should be considered before endodontic surgery. The presence, extent, and location of the lesion and its relation to the mandibular canal can be predictably evaluated in a CT scan of the area.     

心理应激对大鼠三叉神经节降钙素基因相关肽表达的影响

目的：使用交流箱心理应激模型，研究心理应激对三叉神经节中降钙素基因相关肽（CGRP）表达的影响。方法：90只SD大鼠，随机分为3组：空白对照组、足部电击组和情绪应激组，采用反转录-聚合酶链作用（RT—PCR）技术，检测应激后不同时间点三叉神经节中CGRPmRNA水平的变化。结果：三叉神经节中CGRPmRNA的表达在应激第1天无显著性差异，后逐渐升高，第7天时达到最高峰．又逐渐降低，但在第14天是与正常对照组相比还是升高了（P〈0．05），去除应激后CGRP的表达逐渐降低，在恢复14d后基本达到正常水平。结论：心理应激可以引起三叉神经节CGRPmRNA表达发生变化，可能是心理应激导致咀嚼肌痛觉敏感的中枢致病因素之一。