摘要目的 探讨基于氢质子磁共振波谱(1 H-MRS)影像自动融合的无框架立体定向技术在脑内病变活检中应用的可行性、安全性与准确性.方法 2011年7月至2013年7月因临床诊断困难而需行活检的连续病例93例,患者均进行基于MRS影像自动融合的无框架立体定向活检.其中男性48例,女性45例;年龄7～76岁,中位年龄47岁.所自患者术前1d常规行MRS检查,根据MRS反映的病变代谢信息确定穿刺靶点,术中应用MRS自动融合技术,将代谢影像融合到新型VarioGuide神经导航无框架立体定向系统,直接引导靶点穿刺活检,同时应用高场强术中MRI进行靶点检查和术中矫正,并在术中检查有无出血等并发症.结果 93例患者均成功实施了1 H-MRS检测,采用1 H-MRS数据自动融入神经导航系统技术,平均每个病灶的融合时间为5 min 6 s.采用1 H-MRS引导立体定向颅内病变活检术88例患者获得明确病理诊断,诊断阳性率为94.6％;4例(4.3％)未获得明确病理诊断,1例活检获得病理诊断与二期开颅手术结果不符.穿刺后靶点血肿2例,其中1例为5 ml,术后新发运动障碍于术后10 d恢复正常;另1例血肿为32 ml,术中MRI检查后及时开颅清除血肿,术后无新发神经功能障碍.结论 基于代谢影像1H-MRS自动融合指导下的神经导航术中MRI辅助无框架立体定向颅内病变活检具有较高的病理诊断阳性率,融合方法简便快捷,在提高手术准确性、安全性方面有一定优势.

abstractsObjective To evaluate the feasibility,reliability and accuracy of the automated magnetic resonance spectroscopy (1H-MRS) guided frameless brain biopsy with intraoperative magnetic resonance imaging (iMRI).Methods Between July 2011 and July 2013,a consecutive series of 93 patients were prospectively enrolled.All the patients had intracranial lesions which need biopsy to confirm the diagnosis.Among them,48 patients were male,45 patients were female.Their age range from 7 years to 76 years,the median age was 47 years.All patients underwent MRS examination.With MRS automatic fusion technique,the metabolic images were integrated into a standard navigation system (Vario Guide) to guide frameless biopsy.High-field iMRI (1.5 T) was used for target inspection,brain shift correction,and intra-operative exclusion of intra-cerebral hemorrhage and other complications.Results For all the 93 patients,1H-MRS based metabolic images could be automatically integrated into a standard navigation system and average fusion procedure could be taken 5 minutes 6 seconds.For 1H-MRS guided stereotactic biopsy of intracranial lesions,the diagnosis yield rate was 94.6％ (88/93).Four cases did not get a clear pathological diagnosis,while 1 case did not match the pathological diagnosis result which obtained by following craniotomy.Technical related complication rate was 2.2％ (2 cases,intra-cerebral hemorrhage),which were intra-operatively depicted with iMRI,and managed properly.Among them,1 case with small volume (5 ml) intracerebral hematoma fully recovered 10 days after surgery without second surgical intervention.One case with large volume intracerebral hematoma (32 ml) was depicted with iMRI,followed by craniotomy and hematoma evacuation in the same session.This case had no new or worsened neurologic deficit post-operatively.Conclusions 1H-MRS based metabolic imaging can be automatically integrated into a standard navigation system and used for frameless brain biopsy.The target can be selected according to the metabolic status of the lesion.Hence,the target can be more accurate.And the pathological diagnosis yield rate is higher.With iMRI,the method is safe,and has high clinical efficacy.