3D Slicer三维重建技术在脑功能区肿瘤手术治疗中的应用价值

目的 探讨3D-Slicer三维重建技术在脑功能区肿瘤手术治疗中的应用价值。方法 回顾性分析2017年9月至2021年12月手术治疗的39例中央区脑膜瘤、21例中央区胶质瘤的临床资料。术前利用3D-Slicer软件将MRI、3D-MPRAGE、3D-TOF-MRA和CEMRV序列影像进行三维重建，评估肿瘤的形态特征、位置、与周围静脉及上矢状窦的关系。以术中所见为标准，采用Kappa系数检验三维重建模型和术中所见的一致性。结果 3D-Slicer三维重建模型评估肿瘤位置、肿瘤与大脑浅静脉关系、肿瘤与上矢状窦关系均具有良好一致性（Kappa系数均为1.000，P<0.01），准确率均为100.0%。对肿瘤形态特征，胶质瘤的评估一致性差（准确率为18.2%；Kappa系数为0.414，P>0.05），脑膜瘤的评估一致性较好（准确率为97.4%；Kappa系数为1.000，P<0.001）。结论 3D-Slicer软件三维重建技术在脑功能区肿瘤手术治疗中具有较高的应用价值，可清晰显示脑组织、脑动脉、脑静脉、肿瘤组织，并三维可视化，对脑组织、大脑浅静脉、动脉及肿瘤的解剖关系进行多方位、多角度的观察，进行个体化的术前设计，术中可以更好地保护大脑浅静脉及功能区脑组织，从而最大化地切除功能区脑肿瘤，减少术后并发症。

Application of three dimensional reconstruction of medical images using 3D-Slicer software to surgical treatment of tumors in the functional areas of the brain

Objective To investigate the application value of three dimensional reconstruction of medical images using 3D-Slicer software to the surgical treatment of tumors in the functional areas of the brain. Methods The clinical data of 60 patients with tumor in the functional areas of the brain (39 meningiomas, 21 gliomas) who underwent microsurgery from September 2017 to September 2021 were analyzed retrospectively. Three dimensional reconstruction by 3D Slicer software using MRI, 3D-MPRAGE, 3D-TOF-MRA and CEMRV images was used to evaluate the morphological characteristics, location, and relationship with peripheral veins and superior sagittal sinus of the tumors. Kappa coefficient was used to analyze the consistency between the 3D reconstruction model and intraoperative findings. Results The tumor location, relationship between tumor and superficial cerebral vein and superior sagittal sinus evaluated by 3D reconstruction model had good consistency with the intraoperative findings (Kappa coefficient=1.000, P<0.01), and the accuracy was 100.0%. For tumor morphological characteristics, the consistency of glioma assessment was poor (accuracy=18.2%; Kappa coefficient=0.414, P>0.05), and the consistency of meningiomas was good (accuracy rate=97.4%; Kappa coefficient=1.000, P<0.001). Conclusions Three dimensional reconstruction using 3D Slicer software has high application value in surgery for the tumors in the functional areas of the brain, which can clearly show the brain, cerebral artery, cerebral venous and tumor tissues in a form of 3D visualization and help to making individualized preoperative plan by multi-faceted and multi-angle observation of the brain tissues, superficial veins, arteries and tumor anatomies so as to protect the superficial cerebral veins and brain tissues and maximize the resection of tumors and reduce postoperative complications during the operation for tumors in the functional areas of the brain.