中国人脑第三脑室MRI立体定向宽度的研究

目的 研究健康中国人脑立体定向标志,为立体定向功能神经外科提供第三脑室影像解剖学数据.方法 采集健康中国成人自愿者脑MR立体定向图像120例,男、女各60例.在T1、T2加权像和FSEIR成像序列轴位像上测量第三脑室的宽度,对三种成像方式所测得的第三脑室宽度值进行对比研究.结果 T2加权像MRI第三脑室的宽度大于T1加权像MRI第三脑室宽度,T2加权像MRI第三脑室的宽度范围在2.0～9.9mm之间,平均为5.09±1.59mm.结论 T2加权像是第三脑室宽度测量的有效成像序列,第三脑室宽度与年龄呈正相关,性别间存在显著性差异.     

中国人MRI立体定向丘脑数字化图谱的研制

目的 探讨建立MRI立体定向数字化图谱的可行性,分析年龄对成人丘脑体积的影响.方法 选取健康中国成年自愿者行立体定向MRI扫描,在MRI上对丘脑进行识别、分割、提取、保存、匹配与三维重建,测量重建后丘脑的体积.结果 三维重建的丘脑表面光滑、形态逼真,清晰的显示了丘脑在标准立体定向空间中的位置,可直观显示,任意角度浏览.男性右侧丘脑体积为5998.17±170.08mm3,左侧为6200.53±195.24.mm3;女性右侧丘脑体积为5999.98±172.55mm3,左侧为6184.98±184.36mm3.结论 基于MRI的人脑结构数字化具有可行性,60岁以上组丘脑体积较60岁以下组明显缩小.     

中国人脑黑质立体定向数字化解剖图谱的研究

目的探讨建立立体定向MRI黑质数字化、可视化图谱的可行性,为立体定向功能神经外科提供解剖学依据。方法健康中国自愿者150人,在标准的立体定向空间内进行全脑扫描,测量黑质体积。选取其中30例利用eFilm软件对黑质中心点坐标进行测量。随机选取1名自愿者,利用其成像数据,对黑质进行三维重建,并对其进行可视化、数字化处理。结果黑质的平均体积左侧为（327．26±24．19）mm3,右侧为（307．28±25．11）mm3,左右侧黑质的体积存在显著性差异（P〈0．05）。黑质中央截面的中心点坐标X、Y、Z分别为（8．45±0．69）mm、（一4．36±0．50）mm和（一9．47±0．80）mm,左右侧黑质的中心点坐标无显著性差异（P〉0．05）,性别之间黑质的中心点坐标亦无显著性差异（P〉0．05）。结论建立立体定向MRI黑质数字化、可视化图谱是可行的。     

采用立体定向MRI技术对健康中国人颅内脑脊液体积的研究

目的利用立体定向MRI数据和计算机技术对健康中国人颅内脑脊液体积进行研究。方法对120例健康成年自愿者按立体定向基线行轴位全脑MRI扫描，并利用计算机技术对其颅内脑脊液进行识别、分割、提取、匹配与测量，并对脑室进行三维重建。结果男性脑脊液体积为（163．89±34．98）mm^3，女性为（149．71±33．91）mm^3，两者之间无显著性差异（P〉0．05）；60岁以上者脑脊液体积较60岁以下者明显增加（P〈0．05）。重建的脑室系统结构清晰，表面光滑，可任意角度观察。结论脑脊液体积与性别无关，而与年龄有关，当年龄大于60岁时。脑脊液体积开始增加。     

中国人脑丘脑底核MRI立体定向解剖学研究

目的 研究中国人脑丘脑底核(STN)MRI立体定向三维靶点坐标和体积,为帕金森病立体定向手术提供解剖学数据.方法 采集健康中国自愿者人脑MRI图像120例,在标准立体定向空间内测量STN的质心坐标和体积,并对比研究不同年龄组间数值差异及其与年龄问的相关性.结果 STN质心坐标与年龄存在相关性(P＜0.05),左侧STN体积＞右侧,STN体积与年龄呈负相关(P＜0.05).结论 中国人脑STN三维靶点坐标和体积能够在MRI立体定向空间下准确获取,并为临床实际应用奠定基础.     

脑前连合和后连合立体定向MRI研究及其临床意义

目的 研究健康中国人腩立体定向标志前连合(AC)、后连合(PC),为立体定向功能神经外科捉供基础数据.方法 采集健康中国成人自愿者脑MRJ图像120例,男女各60例.在正中矢状面上分别测量AC、PC的宽度和AC-PC的长度(LI),采用统计学方法 分析LI与年龄的相关性及性别差异,并将颅长纳入比较.结果 LI的长度在19.70～25.65 mm之间,平均为(22.92±1.13)mm;AC、PC平均宽度分别为(2.30±0.37)mm、(1.60±0.31)mm;本组中国成人各年龄段组人脑LI长度与年龄无相关性,男性LI长度大于女性,差异有统计学意义(P＜0.05),将颅长纳入比较后,这种差异性消欠了:AC、PC的宽度与年龄无相关性,AC的宽度女性大于男性,PC的宽度性别差异无统计学意义.结论立体定向功能神经外科中AC-PC线是稳定的脑内结构测量参考线.     

中国人脑MRI立体定向活体尾状核数字化的三维重建

依据1例38岁成年男性健康志愿者的MRI立体定向尾状核资料建立个体化数字化图谱。在以AC-PC线为基准线的标准脑立体定向空间对志愿者做1 mm层厚,间距0 mm的MR轴位和冠状的脑扫描,利用哈尔滨工业大学生物研究中心研究开发的软件系统对经MRI扫描后转存的尾状核图像进行三维重建,软件提取分割的尾状核轮廓后执行重建命令。三维重建的尾状核表面光滑、形态逼真,首次清晰地显示了健康国人活体尾状核在大脑标准立体定向空间中的位置,可直观显示,并能从任意角度浏览尾状核的形态。提示基于MRI资料的个体人脑结构数字化、可视化的三维重建具有可行性。     

中国人脑立体定位MRI海马结构体积的测定

目的 测量标准立体定位空间获得的健康中国人脑MRI海马结构的体积,为应用体积测量方法早期诊断颞叶癫痫等疾病提供影像学的参考标准.方法 在标准立体定位空间对100例健康中国人脑进行T1加权像MRI扫描,在冠状位MRI上应用软件测量海马结构的体积,并进行相关统计学分析.结果 在标准立体定位空间MRI能够较清晰、真实的显示海马结构.男女海马结构体积分别为2981.39±297.47 mm3和2970.43±330.13 mm3,性别之间海马结构的体积差异无显著性意义(P＞0.05);左右侧体积分别为2949.67±327.06mm3和3001.81±298.97mm3 ,左右侧海马的体积存在显著性差异(P＜0.05),右侧大于左侧.在20～29岁、30～39岁、40～49岁、50～59岁组间MRI海马结构的体积差异无显著性意义(P＞0.05),而20～29岁、30～39岁、40～49岁、50～59岁组与60～69岁组间经统计学分析发现具有显著性差异(P＜0.05),60岁以后,海马体积逐渐缩小.结论 在标准立体定位空间获得的海马结构体积与性别无关,右侧海马结构体积大于左侧(P＜0.05).60岁以后,海马结构体积随年龄增加而逐渐缩小,因此在MRI影像学诊断海马结构病变时应给予重视.     

MRI立体定向尾状核个体化数字化图谱的研究

目的探讨依据MRI立体定向尾状核资料建立个体化数字化图谱的可行性。方法对1例成年男性健康自愿者在标准的脑立体定向空间做1mm层厚，间距0mm的MR轴位和冠状位脑扫描，对经MRI扫描后转存的尾状核图像进行识别、分割、提取、匹配与三维重建。结果三维重建的尾状核表面光滑、形态逼真，清晰地显示了个体尾状核在标准立体定向空间中的位置，可直观显示，并能从任意角度浏览尾状核的形态。结论基于MRI资料的个体人脑结构数字化、可视化的三维重建具有可行性．但需解决计算机自动化识别、自动配准和分割问题。     

帕金森病手术相关靶点MRI定位解剖的研究

目的探讨MRI定位帕金森病手术相关靶点的准确性和实用性。方法采用T1序列对76例活体人脑前后连合间径(LI)在MRI上的长度进行测量;采用自旋回波翻转恢复序列和T2序列对10名健康人以LI为扫描基线,行3mm层厚、无间距的矢状位、轴位和冠状位头部MRI扫描,分析帕金森病手术相关靶点的MRI位置、影像学特点。结果76例活体人脑MRI上的LI平均长度为22.90±1.30mm;丘脑底核(STN)和苍白球内侧部(GPi)在MRI上清晰显示,其靶点坐标STN为中线旁开12.01±1.25mm,原点后0.62±1.07mm,AC-PC平面下3mm;GPi为中线旁开19.99±1.48mm,原点前3mm,AC-PC平面下3.20±1.24mm。腹内侧中间核(Vim)为MRI不可见靶点,但可根据AC、PC、AC-PC连线和三脑室进行直观、简便的推算。结论MRI可直接、准确地显示脑内一些帕金森病手术相关靶点。     

Intracranial Dissemination from Spinal Cord Anaplastic Astrocytoma

We report a case of intracranial dissemination developing approximately 4 months after partial removal of a spinal cord anplastic astrocytoma in a 22-year-old male. He presented with paraplegia on initial admission at a local hospital. Spinal magnetic resonance (MR) images disclosed multiple intramedullary lesions at the T3-11. The tumor was partially removed. The final histologic diagnosis was anaplastic astrocytoma. Four months after the operation, he was admitted with the symptoms of headache and deterioration of consciousness. MR images showed enhanced lesions in the anterior horn of the left lateral ventricle, and septum pellucidum. He underwent computed tomography-guided stereotactic biopsy and histological appearance was consistent with anaplastic astrocytoma. The clinical course indicates that the tumor originated in the spinal cord and extended into the subarachnoid space, first the spinal canal and later intracranial.     

计算机辅助立体定向三叉神经半月节射频热凝术+甘油注射治疗原发性三叉神经痛(附26例报道)

目的探讨Brainlab立体定向手术计划系统及图像融合技术在三叉神经半月节射频热凝术+甘油注射治疗中的应用价值。方法对26例原发性三叉神经痛患者常规行MR扫描,头部安装Leksell立体定位头架后行CT扫描,将CT及MR图像输入Brainlab立体定向手术计划系统进行图像融合,直接定位半月神经节并确定穿刺路径。结果所有患者一次性穿刺成功率100%,无穿刺损伤所致并发症,术后疼痛立即消失,疗效优良率100%,术后面部感觉减退5例,均无特殊不适感。术后随访半年～1年,无继续服药患者及复发病例。结论立体定向图像融合技术能直接定位三叉神经半月节,并能对穿刺路径进行设定,结合术中电生理定位,确保能快速准确穿刺靶点,避免了穿刺的盲目性,显著提高了穿刺的准确性和治疗效果。     

Diencephalic changes in traumatic brain injury: relationship to sensory perceptual function

Magnetic resonance (MR) imaging scans of 33 traumatically brain-injured (TBI) patients were compared quantitatively to MR scans of controls matched for age and gender. Quantitative estimates of thalamic, internal capsule, and third ventricle morphology were obtained in each TBI patient. Comparisons were made to normal control subjects and revealed significant reduction in thalamic volume with corresponding increase in third ventricle. Measurements of internal capsule reflected nonsignificant changes. Significant correlations were observed between sensory-perceptual functioning, as measured by the Reitan-Klove Sensory-Perceptual Exam, and thalamic volume in TBI patients. A decrease in thalamic volume was associated with an increase in sensory-perceptual errors.     

磁共振导向立体定向扣带回毁损靶点定位及毁损范围的研究

目的 探讨磁共振导向立体定向扣带回毁损的最佳靶点及毁损灶范围. 方法 回顾性分析71例行磁共振导向立体定向扣带回毁损患者的资料,其中慢性疼痛7例.精神疾病64例;扣带回靶点选择为:X:5mm,Y:侧脑室尖后10～20mm,Z:侧脑室上2 mm,并根据磁共振三维定位影像确定及调整靶点及毁损范围;用温控射频仪制作毁损灶,电极直径1.6mm,尖端裸露4mm,毁损温度75℃,时间100 S,毁损灶大小15 mm×10 mm×10 mm.全部患者分别于术后3 d及2月行影像复查.结果 所有患者术后影像复查显示毁损灶完全位于扣带回前部;2例发生短暂性尿失禁,无永久性并发症发生;7例慢性疼痛术后疼痛缓解满意,64例精神疾病手术后结果为优3例,显著进步35例,进步22例,无效4例. 结论 利用磁共振导向行立体定向扣带回毁损手术可以清晰的辨认出扣带回形态及周围结构,最佳的靶点毁损范围为胼胝体顶向后10～25 mm,扣带回底向上高10 mm,宽10 mm.     

Ventricular fluid neuropeptides in Parkinson's disease. I. Levels and distribution of somatostatin-like immunoreactivity

We have measured somatostatin-like immunoreactivity SLI in cerebroventricular fluid of patients with Parkinson's disease (PD) and other extrapyramidal disorders with hyperkinesia. Patients with PD showed a significantly lower concentration of SLI when compared with levels in control patients with chronic stable multiple sclerosis or temporal lobe epilepsy. Less markedly decreased levels of SLI were also noted in patients with torsion dystonia. Of two patients with Huntington's disease one showed a high and one a medium concentration of SLI. According to the site of the stereotactic cannula, verified by ventriculopathy, SLI concentrations in CSF specimen obtained from the foramen Monro tended to be higher than in specimen from a supraforaminal level. Of 5 other patients with lateral and third ventricle being accessible during the passage of the stereotactic cannula, 4 showed higher SLI concentrations in the third ventricle compared to the lateral ventricle. High performance liquid chromatographic analysis combined with radioimmunoassay showed molecular heterogeneity of SLI in CSF. The ratio of SST-14 to SST-28 was higher in the third ventricle than in the lateral ventricle.     

立体定向功能神经外科CT和MR扫描基线——鼻翼耳廓软骨下缘线

目的寻找一条简单实用而又较精准的脑前、后连合连线(AC-PC线)的体表投影线。方法 102例接受立体定向功能神经外科的病人。术中以鼻翼耳廓软骨下缘连线安装头架,并以此线为基线进行CT或MR定位扫描。定位影像输入Elekta SPS手术计划系统。在SPS系统中对鼻翼耳廓软骨下缘线和真实的AC-PC连线的距离、两者的夹角大小等项目进行观察和测量。结果在以平行于鼻翼耳廓软骨下缘线进行的CT或MR4mm层厚的扫描中,AC-PC点全都存在同一层面中。鼻翼耳廓软骨下缘线与AC-PC的夹角最大5°,平均2.15°,相距最大4mm,平均2mm。结论鼻翼耳廓软骨下缘线是在所有现有的CT和MR扫描基线中与AC-PC连线平行度最高的,临床上十分方便实用。是最理想的立体定向功能神经外科的CT和MR扫描基线。     

Endoscopic third ventriculostomy associated 3D-construcive inference steady state MRI for obstructed hydrocephalus: A retrospective study

Background

Endoscopic third ventriculostomy (ETV) is a developing therapeutic stratagem for obstructive hydrocephalus (OH). The aim of this study was to determine the relevance of third ventricle diagnostic imaging by three-dimensional constructive inference in steady state (3D CISS) MRI in patients with OH and to access the preoperative and postoperative values of this technique in patients undergoing endoscopic third ventriculostomy (ETV).

Methods

Forty-six patients with an existing obstruction below the posterior part of the third ventricle underwent 3D CISS sequence MRI on a 1.5 T superconductive MR scanner and were included into this retrospective study. 19 patients were treated with ETV. Regression analysis of the correlation between third ventricle enlargement (TVE) and hydrocephalus degree (HD) and between TVE and third ventricle floor thickness (TVFT) was calculated. In the 19 ETV cases the incisions were marked according to MR images, and the 3D-CISS sequence imaging and the surgical outcome were compared before and after ETV.

Results

By virtue of 3D-CISS 97.83% third ventricle floors and 91.30% basilar arteries (BA) could be visualized, and there was a positive correlation between TVE and HD and a negative correlation between TVE and TVFT in this group. All incision sites on the scalp could be marked correctly. The degree of enlargement of the third ventricle allowed a prediction of the technical challenge to puncture the third ventricle floor. The position and route of BA could be demonstrated avoiding intraoperative iatrogenic lesions. At follow-up, 100% of the fistulas of the third ventricle floor could be measured on 3D-CISS images. The mean diameter of the fistulas was 6.12 ± 0.96 mm; in 91.67%, new CSF fluid directions could be demonstrated; in 83.33%, enlarged ventricle system got withdrawn, and 91.67% patients showed relief of initial symptoms. 1 patient needed the implantation of a ventriculoperitoneal shunt 7 months after EVT. The preoperative HD compared with postoperative HD (P < .01); the preoperative TVE compared with postoperative TVE (P < .05).

Conclusion

Images of the 3D-CISS sequence on MRI can visualize the third ventricle accurately and provide a reliable method for the evaluation of ETV pre- and postoperatively. The degree of enlargement of the third ventricle in patients with obstructive hydrocephalus is associated with the thickness of third ventricle floor and allows a prediction of the difficulty to puncture in ETV.     

Integration of digital angiography, magnetic resonance, x-ray computed tomography and positron emission tomography in stereotaxy

Consecutively to drastic changes which occurred in cerebral imagery techniques, we have developed a stereotactic apparatus and system based on the integration of several new techniques allowing visualisation of the brain: tomodensitometry (TDM), digital subtraction angiography (DSA), magnetic resonance (MR) and positron emission tomography (PET). TDM, DSA and MR can be performed in stereotactic conditions with the apparatus in situ. They give the computer the anatomic references necessary for all calculations. MR and PET images obtained without stereotactic apparatus can also be integrated into the stereotactic study at the condition that DSA was formerly performed in stereotactic conditions, i.e. with the apparatus in situ. The visualisation of the corpus callosum makes this integration possible. An optimal definition of cerebral tumors or target-structures for intracerebral electrode recording is thus obtained.     

磁共振3D-CISS序列检查在三脑室造瘘术前后的意义

目的 探讨三脑室的MR3D—CISS（three dimensional constructive inference in steady state）序列扫描对梗阻性脑积水病人诊断分析意义，及其在内镜三脑室底造瘘（endoscopic third ventriculostomy ETV）手术前后的临床血用价值。方法采用回颐性分析方法，对本组46例梗阻性脑积水在1．5T超导MRI仪行3D—CISS序列扫描，通过对MRI图像的观察、测量来分析三脑室扩大程度与三脑室底厚度、脑积水程度的相关程度：对本组中行单纯神经内镜下ETV手术的12例病人作手术前后3D—CISS序列扫描的较为详细的影像学评价。结果梗阻性脑积水三脑室扩大程度与三脑室底的厚度、脑积水程度均具有明显的相关性。3D—CISS三脑室底清晰显示率达96％（44／46），基底动脉（BA）显示率达91％（42／46）：ETV术前可根据矢状位3D—CISS扫描，作切口的体表定位，充分了解三脑室扩大程度与三脑室底厚簿即穿刺造瘘的难易，可了解基底动脉的方位并通过确定造瘘点避免其损伤；术后行3D—CISS可测量瘘口大小、观察CSF的流动方向、评价手术效果。结论3D—CISS序列技术在显示三脑室方面敏感精确，为ETV手术前后评价提供了可靠依据。梗阻性脑积水三脑室扩大程度决定三脑室底的厚度与术中造瘘的难易。     

Anesthetic protocol: propofol use in Rhesus macaques (Macaca mulatta) during magnetic resonance imaging with stereotactic head frame application

Magnetic resonance image (MRI) guidance is often necessary for accurate targeting for stereotactic intracranial surgery in animals used for experimental research studies. The magnetic field created by the MR imaging equipment, logistics of the use of stereotactic head frame in confined space and the need to limit movement of the subject during the imaging creates unique challenges. We demonstrate in this study the usefulness of intravenous propofol to anesthetize adult Rhesus monkeys to obtain high resolution 3D MR images immediately followed by conversion to inhalation anesthesia and stereotactic intracranial surgery with the head frame 'in situ.' There was minimal morbidity with achieving a high degree of precision for the stereotactic targeting.