影像引导在胶质瘤导航手术中的应用与研究进展

胶质瘤的手术切除原则是在保存重要神经功能的前提下尽可能多地切除肿瘤以减少复发率,但术中肉眼识别肿瘤边界较为困难,而影像引导技术在辅助外科胶质瘤手术中通过实时成像有助于保护神经、提高肿瘤切除率和改善病人预后情况。现就CT、MRI、多模态影像技术、荧光影像导航技术、新材料及靶向探针在胶质瘤手术中的临床应用、优势和局限性,以及研究进展进行综述。     

神经外科术中磁共振成像对麻醉的影响

目的探讨MRI技术用于神经外科手术时对麻醉的影响。方法选取60例胶质瘤患者,随机分为两组,30例在术中磁共振成像(iMRI)及功能神经导航指导下行开颅胶质瘤切除(iMRI组),30例在功能神经导航指导下行传统开颅胶质瘤切除(N组),记录两组患者一般情况、麻醉时间、手术准备时间、手术时间、术中出血量、输液量、输血率、术前及术后血红蛋白浓度、术后体温、肌肉松弛剂用量、围术期与iMRI及麻醉相关的意外情况等。结果与N组比较,iMRI组患者一般情况、麻醉时间、术中出血量、输液量、输血率、血红蛋白浓度及术后体温均无显著差异(P>0.05),但手术准备时间、手术时间明显延长,肌松药用量明显增加(P<0.05)。两组均无与iMRI及麻醉相关的意外发生。结论 iMRI用于神经外科手术提高了手术精确度,使肿瘤切除更彻底,但手术时间明显延长,而其他围术期特点与传统神经外科手术并无差别。iMRI用于神经外科手术时的麻醉处理在遵循一般神经外科麻醉处理原则的基础上,还应关注长时间手术的麻醉调控。     

切伦科夫光学成像研究进展

分子影像技术在疾病的诊断、治疗和疗效评估中发挥着重要作用,多模式分子影像能集多种不同显像设备的特点,提供更多的信息.切伦科夫核素光学成像为新兴的分子影像学方法,其利用放射性核素发射的带电粒子在介质中运行速度大于光速时产生的荧光进行成像,信号强度与放射性活度有关,并与SPECT或PET显像信号具有良好的线性相关性.以此可使用一种分子探针进行SPECT或PET显像及切伦科夫光学成像.     

冠状动脉旁路移植术中的红外热像图监测分析

目的: 应用自主研发的医用热成像诊断系统,采集冠心病病例术前及冠状动脉旁路术中心肌热成像数据加以对比分析,以期为冠心病诊疗提供新的方法.材料和方法: 对12例临床确诊冠心病(多支病变)行常规冠状动脉旁路移植术的患者,于术前及术中行红外热成像数据采集,并与心电图、冠脉造影术、心肌断层核素显像结果相对比.结果: 所有研究对象均顺利采集到相应时段的心肌温度数据及热区分布变化图.红外热成像所显示的缺血心肌区域与心电图、冠脉造影术、心肌断层核素显像一致.结论: 红外热成像技术作为一种新型医学诊断手段,可安全、有效地应用于冠心病诊疗过程的动态监测并具有指导治疗意义.     

神经导航系统在经蝶窦鞍区肿瘤切除术中的应用

目的：探讨神经导航系统在经蝶入路鞍区肿瘤切除手术中的应用价值。方法筛选接受手术治疗的鞍区肿瘤患者28例作为研究对象。所有患者均接受神经导航系统指导的经蝶窦鞍区肿瘤切除术治疗,术前首先进行头部螺旋CT及MRI增强扫描,后应用导航系统处理软件进行图像的三位重建,根据神经导航系统制定患者个性化手术计划并标记重要结果,术中应用导航显微镜系统及定位指导手术操作。结果神经导航系统在手术中定位较为准确,误差分析为（1．92±2．55）mm,术中肿瘤完全切除10例,次全切除19例,大部分切除9例,其中次全切除与大部切除患者术后接受放疗治疗,28例患者中21例患者术后明显好转,而6例患者病情基本稳定、无变化,进行性加重患者1例;术后并发症发生结果显示28例患者中均无死亡、严重并发症发生,其中发生一过性尿崩2例,脑脊液漏1例。结论神经导航系统在经蝶窦鞍区肿瘤切除术中具有重要的应用价值,其可进行准确的手术定位,提升手术的安全性,可提高肿瘤的切除率。     

MRCP及核素肝胆动态显像在婴儿持续性黄疸诊断中的价值

目的 探讨磁共振胰胆管成像(MROP)和核素肝胆动态显像在婴儿持续性黄疸诊断中的价值.资料与方法 17例持续性黄疸患儿,男11例,女6例,平均年龄82天.均行腹部MR平扫及MRCP检查,同期行核素肝胆动态显像,将两种检查方法的结果与手术病理及临床治疗结果进行统计学分析和比较.结果 17例经MRCP检查诊断胆道闭锁者9例,胆总管囊肿1例,胆总管远端梗阻1例;腹部未见异常6例.经核素肝胆动态显像诊断胆道闭锁13例、乳儿肝炎4例.12例术后诊断胆道闭锁者8例,术中胆道造影显示胆汁黏稠3例,左右肝管狭窄合并胆汁黏稠1例.经实验室检查证实、治疗后症状好转临床诊断乳儿肝炎5例.结论 在婴儿持续性黄疸的诊断中,腹部MRCP和核素肝胆动态显像技术联合应用具有敏感性、特异性高的特点,对制定手术方案具有重要意义.     

细胞周期素与肿瘤及其分子影像学展望

细胞周期素控制着细胞的增殖,对肿瘤的发生有重要意义。细胞周期素与肿瘤的恶性程度和生物学行为密切相关,并可据其对肿瘤进行分级和分期,以指导临床进行基因治疗。分子影像学的出现和发展,使活体检测细胞周期素成为可能。光学成像、磁共振成像和核素成像均有可能将细胞周期素的检测应用于临床。     

RSNA2015分子影像学

RSNA2015报道的分子影像学研究进展主要包括以下几个方面:①靶向特异性分子探针及复合分子探针的研发和应用:如靶向特异性超顺磁氧化铁纳米探针,放射性核素示踪剂免疫,复合超声微泡对比剂及光学对比剂等,应用于肿瘤血管靶向显像,肿瘤诊断、治疗疗效评估及肿瘤淋巴结转移等.③新型的放射学分子成像方法:如磁性粒子成像,磁共振波谱成像及化学交换饱和转移成像等.③多模态或多参数分子显像:MRI、PET、SPECT、超声及光学分子成像技术中两种或多种技术的结合.④干细胞追踪及显像.     

放射性核素标记Anx Ⅴ细胞凋亡分子成像在肿瘤化疗疗效评估中的价值

细胞凋亡是评价肿瘤化疗疗效的一个重要方面,在靶向凋亡的分子成像技术中,核素显像技术是目前最敏感的技术,以放射性核素标记Anx Ⅴ的凋亡显像技术应用较为广泛.就放射性核素标记AnxV凋亡成像的原理、示踪剂种类、标记法和生物分布特征、体内外研究及临床研究结果进行综述.     

细胞周期素与肿瘤及其分子影像学展望

细胞周期素控制着细胞的增殖,对肿瘤的发生有重要意义.细胞周期素与肿瘤的恶性程度和生物学行为密切相关,并可据其对肿瘤进行分级和分期,以指导临床进行基因治疗.分子影像学的出现和发展,使活体检测细胞周期素成为可能.光学成像、磁共振成像和核素成像均有可能将细胞周期素的检测应用于临床.     

Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures

The goal in brain tumor surgery is to remove the maximum achievable amount of the tumor, preventing damage to “eloquent” brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been introduced, including an operating microscope in the late 1950s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resection cavity and thus overcome this remaining uncertainty of intraoperative MRI in high grade brain tumor resection.     

Translational optical imaging

OBJECTIVE: Optical imaging is experiencing significant technologic advances. Simultaneously, an array of specific optical imaging agents has brought new capabilities to biomedical research and is edging toward clinical use. We review progress in the translation of macroscopic optical imaging-including fluorescence-guided surgery and endoscopy, intravascular fluorescence imaging, diffuse fluorescence and optical tomography, and multispectral optoacoustics (photoacoustics)-for applications ranging from tumor resection and assessment of atherosclerotic plaques to dermatologic and breast examinations. CONCLUSION: Optical imaging could play a major role in the move from imaging of structure and morphology to the visualization of the individual biologic processes underlying disease and could, therefore, contribute to more accurate diagnostics and improved treatment efficacy.     

肿瘤MR分子影像学研究进展

MR分子影像学以分子生物学为基础,借助MRI技术在活体状态下从分子、基因水平对肿瘤进行更早期、更特异性诊断与监测治疗效果。目前关于MR分子影像研究多集中于MR特异性分子探针的制备、肿瘤血管形成显像、报告基因显像、波谱显像等方面,由于MR具有精确的空间定位及功能成像等优势,因此在肿瘤分子影像研究中具有极大的发展潜力,将在21世纪肿瘤的诊断与治疗中发挥重要作用。MR分子影像学以分子生物学为基础,借助MRI技术在活体状态下从分子、基因水平对肿瘤进行更早期、更特异性诊断与监测治疗效果。目前关于MR分子影像研究多集中于MR特异性分子探针的制备、肿瘤血管形成显像、报告基因显像、波谱显像等方面,由于MR具有精确的空间定位及功能成像等优势,因此在肿瘤分子影像研究中具有极大的发展潜力,将在21世纪肿瘤的诊断与治疗中发挥重要作用。     

MR imaging of the brain: tumors

The radiologic modality that most likely provides the imaging information needed in a patient suspected of having a brain tumor is MR imaging. A brain tumor can be reliably ruled out if the MR examination is performed properly and experts interpret the results as negative. If there is a tumor, however, its exact location and topography must be determined. Important for therapy and prognosis are also tumor properties such as histologic type and grade, as well as effects on adjacent brain structures. Although potentially a noninvasive method of in vivo neuropathology, MR is still far from being sufficiently specific, as dissimilar lesions may look the same despite the use of refined imaging protocols. The evolution of MR imaging continues, however, making further methodologic improvement likely. Presently, advanced methods, such as diffusion- and perfusion-weighted MR imaging, functional MR imaging, neuronavigation based on MR imaging data, and the use of MR imaging during surgery (intraoperative MR imaging), influence the way patients are treated. Likewise, follow-up imaging (monitoring) of tumor patients by MR has become more effective, and experience has shown how to distinguish reactive changes from recurrent tumor. In the future, MR imaging may gain importance in the development of novel therapeutic concepts.     

乳腺癌分子成像的应用价值

乳腺癌是女性最常见的恶性肿瘤之一,早期诊断及正确评估其侵袭性是影响乳腺癌病人预后的重要因素。多种分子成像技术(包括超声、磁共振成像、放射性核素显像及光学分子成像)对乳腺癌的诊断、临床亚型判断、治疗方式选择及预后评估均有重要价值。其中,超声靶向微泡治疗和光学分子成像指导乳腺癌手术治疗等技术的发展有望成为乳腺癌治疗的新方式。就多种分子成像技术在乳腺癌中的应用价值予以综述。     

放射性核素骨显像对骨肿瘤样病变的影像学研究价值

骨肿瘤样病变是在病理、影像及临床表现上与骨肿瘤相似的一类疾病.放射性核素骨显像能够比较清楚地显示全身骨骼的形态及骨骼的血液供应和代谢情况,可以早期发现骨代谢的异常,灵敏度高于其他检查.目前关于骨肿瘤样病变的影像学资料以X射线、CT及MRI多见,该文拟对放射性核素骨显像对骨肿瘤样病变的诊断价值进行综述,旨在初步形成系统认识,以帮助临床医师提高对此类疾病的诊断水平.     

Postoperative fluid-attenuated inversion recovery MR imaging of cerebral gliomas: initial results

Fluid-attenuated inversion-recovery (FLAIR) imaging has shown to be a valuable imaging modality in the assessment of intra-axial brain tumors; however, no data are available about the role of this technique in the clinically important postoperative stage. The purpose of this study was to evaluate the diagnostic potential of FLAIR MR imaging in residual tumor after surgical resection of cerebral gliomas. Fifteen patients with residual cerebral gliomas were examined within the first 18 days after partial surgical resection of cerebral gliomas. The imaging protocol included T1-weighted spin echo, T2- and proton-density-weighted fast spin echo, and FLAIR imaging with identical slice parameters. T1 and FLAIR were repeated after contrast media application. Detection and delineation of residual tumor were the primary parameters of the image analysis. Additionally, the influence of image artifacts on the image interpretation was assessed. On FLAIR images residual signal abnormalities at the border of the resection cavities were observed in all patients, whereas T2- and T1-weighted images present residual abnormalities in 13 of 15 and 10 of 15 patients, respectively. The FLAIR imaging was found to be superior to conventional imaging sequences in the delineation of these changes and comparable to contrast enhanced T1-weighted imaging in the delineation of residual enhancing lesions. Because of protein cell components and blood byproducts within the resection cavity, FLAIR imaging was unable to suppress the cerebrospinal fluid (CSF) in 4 patients. After the decomposition of proteins and blood, CSF could again be completely suppressed and residual or recurrent tumors were clearly identified. Our preliminary study has shown that FLAIR may be a valuable diagnostic modality in the early postoperative MR imaging after resection of cerebral gliomas due to its better delineation of residual pathologic signal at the border of the resection cavity. It should therefore be integrated into the early and/or intraoperative MR imaging protocol.     

分子成像技术的研究进展

分子成像是新时代的医学成像,它可以无创性监测活体内的细胞和分子水平的生物学过程,其中包括核医学分子显像、磁共振分子成像、超声分子成像、光学分子成像和X射线分子成像等.目前,由于多学科融合的发展,多模式融合成像技术已成功用于临床,如PET-CT和PET-MRI.随着分子探针的发展和多模式融合成像技术的成熟,越来越多的分子...     

面神经MR成像技术及临床应用

面神经直径小,走行迂曲,难以完整显示。MRI具有高分辨力,对显示面神经及其病变具有重要作用。各种新序列的开发和应用提高了面神经MRI显示率。面神经功能障碍将导致面部肌肉瘫痪,严重影响病人的生活质量和容貌。面神经MR成像有助于明确面瘫原因、显示周围病变与面神经的关系,对术前评估、术中保护面神经具有重要临床应用价值。就近年来对面神经MR成像技术及其临床应用的研究予以综述。     

高场强术中磁共振结合语言功能神经导航技术在胶质瘤手术中的应用

目的探讨高场强术中磁共振系统与语言功能导航技术联合应用对优势大脑半球语言功能区胶质瘤手术切除效果的影响。方法收集2009年2月-2010年7月与优势大脑半球弓形束关系密切的胶质瘤患者20例,男12例,女8例,年龄20~61岁,平均43.6岁,根据术前失语评分(AQ)将患者分为语言功能正常组(n=9)和语言功能障碍组(n=11)。所有患者均接受高场强术中磁共振及弓形束导航辅助下手术,采用1.5T移动磁体、双室设计的术中磁共振系统,术前通过软件将弓形束重建的3D图像整合入神经导航系统,并在术中联合应用显微镜下功能神经导航。术前及术后2~4周、3~6个月进行随访(包括MRI检查及西方失语成套测验)。结果 20例患者均完成术前及术中弓形束重建,将3D重建图像整合入神经导航系统后成功实现了显微镜下导航。术后2~4周,语言功能正常组AQ(94.5±5.5)保持在正常水平,只有1例出现新发的传导性失语症状(AQ=81.8),而语言功能障碍组AQ(89.4±5.8)与术前比较(84.9±8.7)有明显改善(P<0.05)。术后3~6个月,语言功能正常组中除2例因肿瘤复发出现语言功能恶化外,其余患者AQ(98.3±0.5)均在正常范围,而语言功能障碍组AQ(95.2±2.6)较术后2~4周也有了明显改善(P<0.05)。两组患者术后均未出现其他新的神经功能障碍,无死亡病例。结论高场强术中磁共振结合功能神经导航是一项可靠、稳妥的技术,在肿瘤毗邻重要语言功能区及传导束时,可辅助外科手术最大限度地切除肿瘤,减轻神经功能损伤,有利于术后功能恢复。