Glioma surgery using a multimodal navigation system with integrated metabolic images
Glioma surgery using a multimodal navigation system with integrated metabolic images
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DOI：
10.3171/2008.4.17569
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发表时间：
2009-01-01
影响因子：
4.1
通讯作者：
Ohno, Kikuo
中科院分区：
文献类型：
--
作者：
Tanaka, Yoji;Nariai, Tadashi;Ohno, Kikuo
Object.本文描述了一种多模式神经导航系统，该系统使用PET代谢图像和MR图像的解剖图像进行胶质瘤手术。多模式神经导航系统的有效性进行了评估，通过比较的结果与传统的导航系统，常规使用的解剖图像从MR和CT成像作为指导。33例脑胶质瘤患者在多模式或传统导航系统的帮助下接受了36次手术。所有患者均使用L-甲基-[C-11]蛋氨酸（MET）进行PET初步检查，以制定手术计划。其中17例手术是通过将MET-PET图像与解剖MR图像相结合，使用多模式导航系统进行的。其余19例手术均采用单纯基于MR成像的常规导航系统进行。多模式导航系统被证明是更有用的，比传统的导航系统，在确定区域切除提供了一个更清晰的肿瘤边界，特别是在复发性肿瘤，失去了正常的脑回模式的情况下。因此，多模式导航系统在减少可切除部分的肿瘤残留质量方面比传统导航系统更有效。多变量回归分析显示，多模式导航系统引导下的手术比传统导航引导下的手术更有利于患者生存（p = 0.016，优势比0.52 [95%置信区间0.29-0.88]）。作者对两种导航系统进行了初步的机构内比较，提出了多模式导航的可能前提。使用MET-PET融合成像的多模式导航系统是一种有趣的技术，可能在未来被证明是有价值的。(DOI：10.3171/2008.4.17569）
Object. A miltimodal neuronavigation system using metabolic images with PET and anatomical images from MR images is described here for glioma surgery. The efficacy of the multimodal neuronavigation system was evaluated by comparing the results with that of the conventional navigation system, which routinely uses anatomical images from MR and CT imaging as guides.Methods. Thirty-three patients with cerebral glioma underwent 36 operations with the aid of either a multimodal or conventional navigation system. All of the patients were preliminarily examined using PET with L-methyl-[C-11] methionine (MET) for surgical planning. Seventeen of the operations were performed with the multimodal navigation system by integrating the MET-PET images with anatomical MR images. The other 19 operations were performed using a conventional navigation system based solely on MR imaging.Results. The multimodal navigation system proved to be more useful than the conventional navigation system in determining the area to be resected by providing a clearer tumor boundary, especially in cases of recurrent tumor that had lost a normal gyral pattern. The multimodal navigation system was therefore more effective than the conventional navigation system in decreasing the mass of the tumor remnant in the resectable portion. A multivariate regression analysis revealed that the multimodal navigation system-guided Surgery benefited patient survival significantly more than the conventional navigation-guided surgery (p = 0.016, odds ratio 0.52 [95% confidence interval 0.29-0.88]).Conclusions. The authors' preliminary intrainstitutional comparison between the 2 navigation systems suggested the possible premise of multimodal navigation. The multimodal navigation system using MET-PET fusion imaging is an interesting technique that may prove to be Valuable in the future. (DOI: 10.3171/2008.4.17569)