目的 为了更客观、更个性化地体现岩上静脉（Superior petrosal vein, SPV）及其毗邻骨性结构的形态学特点，应用对比增强磁共振血管成像（Contrast enhanced magnetic resonance angiography，CEMRA）和电子计算机断层扫描（CT）相结合的多模态融合技术三维重建岩上静脉复合体及其周围颅骨的正常解剖结构，为解剖学研究和临床手术提供新的参考。 方法 通过对造影剂浓度、造影剂推注速度、开始扫描时间等的调整，扫描得到的3D CEMRA经过图像处理工作站MIP后处理软件判断岩上静脉复合体 （SPVC）显影成功。3D CEMRA与3D-CT的原始数据共同导入3Dslicer软件，通过图像配准、阈值分割、结构修剪和数据打包保存，最后把这两种模态的打包数据共同导入并同时3D融合显现。运用3Dslicer软件的测量模块对相关解剖参数进行测量。 结果 ①得到造影精度分别为乙状窦、岩上窦（Superior petrosal sinus，SPS）、 SPV、 SPV属支的相关造影参数，但是成功率不够稳定；②通过对头部CEMRA和头颅CT的DICOM数据的三维重建，得到SPV及其属支、SPS、乙状窦、横窦和海绵窦等静脉结构，内耳道、岩上窦沟和横窦沟等颅底特别是岩斜区附近的骨性解剖标志；③多模态融合后静脉结构和骨性结构的三维融合图；④运用3Dslicer软件中的测量模块测量的测量图示。 结论 提示影像学与3Dslicer软件的结合可以逼真地展示多模态融合的解剖结构，为解剖形态学的研究提供了新的可能，同时也可以为临床手术提供个性化参考。
Abstract
【Abstract】 Objective To reflect the morphological characteristics of SPV and its adjacent bone structures objectively, contrast enhanced magnetic resonance angiography (CEMRA) and computer tomography (CT) were used by combining with multi-modal fusion technology to reconstruct the normal anatomical structure of the superior petrosal vein complex and its surrounding skull, which providing reference for anatomical research and clinical surgery. Methods By adjusting the concentration of the contrast agent, the injection speed of the contrast agent, the start time of scanning, the scanned 3D CEMRA was judged to be developed successfully by the MIP post-processing of image processing workstation. The original data of 3D CEMRA and 3D-CT were imported into 3Dslicer software together. After image registration, threshold segmentation, structure pruning and data package storage, the packaged data of these two modalities were imported together and 3D fusion was performed at the same time. The related anatomical parameters were measured by using the module of 3Dslicer software. Results ①The relevant angiographic parameters of the sigmoid sinus, superior petrosal sinus (SPS), SPV, and SPV tributary was obtained, but the success rate was not stable; ②Through the three-dimensional reconstruction of the DICOM data from the head CEMRA and cranial CT, SPV and its branch, SPS, sigmoid sinus, transverse sinus and cavernous sinus, bone anatomical landmarks of skull base such as internal auditory canal, petrosal sinus groove and transverse sinus groove near the petrosal area were obtained; ③ Three-dimensional fusion map of venous structure and osseous structure after multi-modal fusion was obtained; ④The measurement diagram was obtained by using the measurement module in the 3Dslicer software. Conclusions The combination of imaging and 3Dslicer software can realistically display the anatomical structure of multi-modal fusion, providing a new possibility for the study of anatomical morphology, and also providing personalized reference for clinical surgery.
关键词
岩上静脉； /
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解剖学； /
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神经外科； /
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影像学； /
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CEMRA； /
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3Dslicer； /
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三维重建； /
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多模态融合
Key words
Superior petrosal vein; /
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Anatomy; /
Neurosurgery; /
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Imaging; /
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CEMRA; /
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3Dslicer /
Three-dimensional reconstruction; /
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Multimodal fusion
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参考文献
[1] Liebelt BD, Barber SM, Desai VR, et al. Superior petrosal vein sacrifice during microvascular decompression: perioperative complication rates and comparison with venous preservation[J]. World Neurosurg, 2017, 104: 788-794. DOI: 10.1016/j.wneu.2017.05.098.
[2] Rhoton A , Matsushima K , Carvalhal Ribas E , et al. Absence of the superior petrosal veins and sinus: surgical considerations[J]. Surg Neurol Int, 2015, 6(1):34. DOI: 10.4103/2152-7806.152147.
[3] Masuoka J, Matsushima T, Hikita T, et al. Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia[J]. J Clin Neurosci, 2009, 16(10):1342-1344. DOI:10.1016/j.jocn.2008.12.024.
[4] Broggi G, Broggi M, Ferroli P, et al. Surgical technique for trigeminal microvascular decompression[J]. Acta Neurochir (Wien), 2012, 154(6): 1089-1095. DOI: 10.1007/s00701-012-1324-2.
[5] Patel SV，Parish DC，Patel RM，et al．Resolution of MRI findings in central pontine myelinosis associated with hypokalemia [J].Am J Med Sci，2007，334(6)：490-492．DOI:10.1097/MAJ.0b013e318068b224.
[6] Ichikawa H, Murakami H, Katoh H, et al. Central pontine lesions observed with MRI in four diabetic patients.[J]. Intern Med, 2008, 47(15): 1425-1430. DOI: 10.2169/internalmedicine.47.0868.
[7] Bender B, Hauser TK, Korn A, et al. Depiction of the superior petrosal vein complex by 3D contrast-enhanced MR angiography[J]. AJNR Am J Neuroradiol, 2018, 39(12): 2249-2255. DOI: 10.3174/ajnr.A5864.
[8] 邱宇, 李军, 陈鹏, 等.多模态影像融合技术在复杂颅底肿瘤手术中的应用[J].精准医学杂志, 2020, 35(5): 437-440. DOI：10.13362/j.jpmed. 202005013.
[9] Haq IBI, Susilo RI, Goto T, et al. Dural incision in the petrosal approach with preservation of the superior petrosal vein[J]. J Neurosurg, 2016, 124(4):1074-1078. DOI: 10.3171/2015.3.JNS141618.
[10] Matsushima K, Matsushima T, Kuga Y, et al. Classification of the superior petrosal veins and sinus based on drainage pattern[J]. Neurosurgery, 2014,10(2):357-367. DOI:10.1227/NEU. 000000000000 0323.
[11]Inoue T, Hirai H, Shima A, et al. Diagnosis and management for trigeminal neuralgia caused solely by venous compression[J]. Acta Neurochir (Wien), 2017, 159(4): 681-688. DOI:10.1007/s00701-017-3085-4.
[12]Xia L, Liu MX, Zhong J, et al. Fatal complications following microvasculardecompression: could it be avoided and salvaged?[J]. Neurosurg Rev, 2017, 40(3): 389-396. DOI:10.1007/s10143-016-0791-y.
[13]Liebelt BD, Barber SM, Desai VR, et al. Superior petrosal vein sacrifice during microvascular decompression: perioperative complication rates and comparison to venous preservation[J]. World Neurosurg, 2017, 104: 788-794. DOI:10.1016/j.wneu.2017.05.098.
[14]Lee MH, Jee TK, Lee JA, et al. Postoperative complications of microvascular decompression for hemifacial spasm: lessons from experience of 2040 cases[J]. Neurosurg Rev, 2016, 39(1):151-158. DOI: 10.1007/s10143-015-0666-7.
[15]Hiroki T, Koichi I, Naoya Y, et al. Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm[J]. Neurosurg Focus, 2018, 45(1): E2. DOI:10.3171/2018.4.FOCUS18122.
[16]Tanriover N, Abe H, Rhoton AL, et al. Microsurgical anatomy of the superior petrosal venous complex: new classifications and implications for subtemporal transtentorial and retrosigmoid suprameatal approaches[J]. J Neurosurg,2007, 106(6):1041-1050. DOI:10.3171/jns. 2007. 106.6.1041.
[17]Xiong NX, Zhou X, Yang B, et al. Preoperative MRI evaluation of relationship between trigeminal nerve and superior petrosal vein: its role in treating trigeminal neuralgia[J]. J Neurol Surg A Cent Eur Neurosurg, 2019, 80 (3): 213-219. DOI:10.1055/s-0038-1669399.
[18]Kuhnt D, Bauer MHA, Nimsky C. Brain shift compensation and neurosurgical image fusion using intraoperative MRI: current status and future challenges[J]. Crit Rev Biomed Eng, 2012, 40(3): 175-185. DOI: 10.1615/critrevbiomedeng.v40.i3.20.
[19] 陈忠仪, 洪文瑶, 廖正俭, 等.多模态影像融合技术联合3D打印技术在经蝶垂体腺瘤切除术中的应用[J].实用临床医学,2018,19(08):42-44. DOI: 10.13764/j.cnki.lcsy.2018.08.011.
[20] 冯素银, 黄进, 程超, 等.多模态神经导航影像融合功能在复发垂体腺瘤手术中的应用[J].江苏医药, 2014, 40( 20) : 2442－2444. DOI: 10.19460/j.cnki.0253-3685.2014.20.023.
[21] 吴东东,卜博, 陈晓雷, 等. 融合MRI与CT图像的多模态神经导航技术在颅底显微外科手术中的应用[J].解放军医学院学报, 2015, 36( 5) : 441-444. DOI: 10.3969/j.issn.2095-5227.2015.05.002.
[22] 陈争珍, 乔会煌, 郭玉, 等. 脑深髓静脉的磁敏感加权成像[J].解剖学报, 2016, 47(6):796-801. DOI:10. 16098/j. issn. 0529-1356. 2016. 06. 013.
[23] Matsushima T, Rhoton AL, Oliveira ED, et al. Microsurgical anatomy of the veins of the posterior fossa[J]. J Neurosurg, 1983, 59(1):63-105. DOI: 10.3171/jns.1983.59.1.0063.
基金
国家重点研发计划（2017YFC1103400）；广东省科技计划项目（2016B090917001）；广东省科技计划项目(2018B090944002) ；深圳市医疗卫生“三名工程”高层次医学团队（SZSM201612019）
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