摘要：
Objective To explore the clinical application of multimodal image fusion in stereotactic biopsy of intracranial lesions.Methods A total of 34 patients underwent multimodal image-guided stereotactic biopsy and were enrolled into this study from January to December 2016 at Department of Neurosurgery,the First Affiliated Hospital,College of Medicine,Zhejiang University.Images including PET/ CT,1H-MRS,BOLD-fMRI,DTI were fused with structural MRI for target confirmation and trajectory design.Framed stereotactic biopsy was performed in 14 patients and frameless stereotactic biopsy was performed in the other 20 patients.The diagnostic yield and complications of biopsy were assessed.Results Stereotactic biopsy was successfully performed in all cases including 32 with supratentorial lesions and 2 with infratentoria lesions.Post-biopsy pathology revealed glioma in 14 patients,lymphoma in 12,metastatic tumors in 6 and inflammatory demyelinating diseases in 2.The diagnostic yield was 100％.Post-biopsy CT confirmed the accuracy of biopsy targets.A small hematoma (＜ 5 ml) in target area was found in 1(2.9％,1/34) patient without severe complications and no further operation was performed.There was no bleeding in any trajectory or newly-occurred neurological deficits.Conclusion Multimodal image fusion could provide anatomical,metabolic and functional information for stereotactic biopsy,increase diagnostic yield and reduce complications.%目的 探讨多模态影像融合技术在颅内病变立体定向穿刺活检中的作用.方法 回顾性纳入2016年1月至12月浙江大学医学院附属第一医院神经外科在MRI结构影像基础上结合正电子发射断层显像术(PET)/CT、氢质子磁共振波谱(1H-MRS)、血氧水平依赖功能磁共振成像(BOLD-fMRI)、弥散张量成像(DTI)等多模态影像融合技术规划穿刺靶点和路径,进行立体定向活检术的患者,共34例.其中有框架穿刺14例,无框架导航穿刺20例,记录诊断的阳性率、并发症等.结果 34例患者均成功实施立体定向穿刺活检,其中32例为幕上病变,2例为幕下病变.术后病理诊断胶质瘤14例,淋巴瘤12例,脑转移瘤6例,炎性脱髓鞘2例,诊断阳性率为100％.术后影像学证实靶点均按术前计划精确定位.1例(2.9％,1/34)出现穿刺靶点小血肿(＜5 ml),未行手术处理,无严重术后并发症.所有患者均未出现穿刺道出血,未发生新发神经功能障碍.结论 多模态影像融合技术可提供颅内病变的解剖、代谢及功能信息,提高穿刺活检的成功率,降低并发症.
