磁共振T2、SWI定位丘脑底核在帕金森脑深部电刺激术中的对比研究

A comparative study of magnetic resonance T2 and SWI localization of the subthalamic nucleus in deep brain stimulation of the Parkinsonian disease

摘要:

目的 探究磁共振T2序列及SWI序列在丘脑底核（Subthalamic Nucleus，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月神经外科行帕金森病DBS手术且符合本次研究纳入标准的患者，共计11人，所有病人术前均行3.0T高分辨率磁共振成像扫描3DT1 bravo、T2、磁敏感加权（Susceptibility Weighted Imaging ，SWI）序列。分别利用可直视靶点的T2序列或SWI序列制定手术计划并生成相应手术坐标，所有患者均行双侧丘脑底核脑深部电极置入术，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 计算对比两侧T2及SWI坐标Z轴差值，结果为左侧SWI较T2深2.16±1.02mm；右侧SWI较T2深2.13±1.62mm。 结论 1.SWI序列在成像效果上及对靶点核团的边界显示优于T2序列。 2.STN在SWI序列上深度比在T2序列显示的深2mm左右且更符合电生理深度。 3.实际置入电极坐标较T2计划坐标偏后，但实际坐标相较于SWI序列计划坐标无明显差异。

Abstract:

Objective: To explore the visualization effect and imaging clarity of magnetic resonance T2 sequence and SWI sequence in the Subthalamic Nucleus (STN), to study the error between the surgical target located by different sequences and the actual target, and to calculate the error amount, to guide the preoperative surgical planning and imaging selection. Research methods: A total of 11 patients, who received DBS surgery for Parkinson""s disease in the Department of Neurosurgery of the First Affiliated Hospital of Henan University from December 2018 to December 2020 and who met the inclusion criteria of this study were collected and analyzed. After rigorous preoperative evaluation, all patients received preoperative 3.0T magnetic resonance Imaging, and 3DT1 Bravo, T2, and Susceptibility Weighted Imaging (SWI) sequences were scanned. T2 sequence and SWI sequence were used to formulate the surgical plan and generate the corresponding surgical coordinates. All patients received bilateral subthalamic nucleus deep brain electrode implantation, a total of 22 sides. High-resolution thin-layer craniocerebral CT was reexamined postoperatively and fused with preoperative MRI. The location coordinates of the electrode tip were reconstructed after surgery and compared with the coordinates of the T2 plan and the coordinates of the SWI plan respectively to analyze the error values. Results: The Z-axis difference between T2 and SWI coordinates on both sides is calculated and compared. The result is that the left SWI is 2.16±1.02mm deeper than T2. The right SWI is 2.13±1.62mm deeper than T2. Conclusions: 1. SWI sequences show superiority over T2 sequences in terms of imaging effect and boundary display of target nucleus. 2. The depth of STN in the SWI sequence is about 2mm deeper than that in the T2 sequence, and it is more consistent with the electrophysiological depth. 3. The actual implanted electrode coordinates are backward compared to the T2 planned coordinates，However, there is no significant difference between the actual coordinates and the SWI sequence planning coordinates.