磁共振T2、SWI序列定位丘脑底核在帕金森病脑深部电刺激术中的对比研究

Magnetic resonance T2 or SWI localization of the subthalamic nucleus in deep brain stimulation for Parkinson’s disease: A comparative study

摘要:

目的 探究磁共振T2序列及磁敏感加权（SWI）序列在丘脑底核（STN）的可视化效果及成像清晰度，研究不同序列定位的计划靶点与实际靶点的误差，并计算出误差量，以指导术前手术计划制定及影像学选择。方法 收集并分析河南大学第一附属医院2018年12月—2020年12月因帕金森病行脑深部电刺激术（DBS）且符合本次研究纳入标准的患者，共计11例，所有患者术前均行3.0 T高分辨率磁共振成像扫描3DT1 bravo、T2、SWI序列。分别利用T2序列或SWI序列制定手术计划并生成相应手术坐标，所有患者均行双侧STN行DBS，共计22侧，术后复查高分辨率薄层颅脑CT并与术前MRI融合。术后重建电极尖端位置坐标，分别与T2计划坐标、SWI计划坐标两两对比，分析误差值。结果 以T2为参考计划坐标与SWI为参考计划坐标对比。在两侧Z轴上，差异有统计学意义（P＜0.05），左侧SWI较T2深（2.16±1.02）mm；右侧SWI较T2深（2.13±1.62）mm。结论 STN在SWI序列上显示的深度比在T2序列显示的深2 mm左右且更符合电生理深度。

Abstract:

Objective To investigate the visualization effect and imaging clarity of magnetic resonance T2 sequence versus susceptibility-weighted imaging （SWI） sequence in the subthalamic nucleus （STN） and the error between the surgical target located by different sequences and the actual target， to calculate the error amount， and to guide preoperative surgical planning and imaging selection.Methods A total of 11 patients who received deep brain stimulation for Parkinson’s disease in The First Affiliated Hospital of Henan University from December 2018 to December 2020 and met the inclusion criteria of this study were enrolled and analyzed， and all patients underwent preoperative 3.0T high-resolution magnetic resonance imaging with 3DT1 Bravo， T2， and SWI sequences. T2 sequence and SWI sequence were used to formulate the surgical plan and generate the corresponding surgical coordinates， and all patients received deep brain electrode implantation in the bilateral STN， with a total of 22 sides. High-resolution thin-layer craniocerebral CT was reexamined after surgery and was fused with preoperative MRI. The location coordinates of the electrode tip were reconstructed after surgery and were compared with the coordinates of the T2 plan or the SWI plan to analyze the error amount.Results As for the Z-axis difference， the coordinate of left SWI was 2.16±1.02 mm deeper than that of T2， and the coordinate of right SWI was 2.13±1.62 mm deeper than that of T2.Conclusions The depth of the STN on the SWI sequence is about 2 mm greater than that on the T2 sequence and is more consistent with the electrophysiological depth.