摘要
目的探讨帕金森病脑深部电刺激(DBS)术前应用三维液体衰减反转恢复序列(3D-FLAIR)定位丘脑底核(STN)的效果。方法前瞻性纳入2021年3月至2022年9月哈尔滨医科大学附属第一医院神经外科行双侧STN-DBS治疗的帕金森病患者40例。按照单纯随机抽样方法分为两组,其中20例术前采用T2加权成像(T2WI)定位STN靶点(简称T2WI组),另20例采用3D-FLAIR定位靶点(简称3D-FLAIR组)。分别计算T2WI与3D-FLAIR上STN与周边白质的对比度;计算实际电极位置在平行前连合-后连合的轴位平面上的径向误差。比较两组患者的基线资料、STN与周边白质的对比度、开机6个月药物关期统一帕金森病评定量表第三部分(UPDRS-Ⅲ)评分及其改善率。结果两组患者性别、年龄、病程、术前UPDRS-Ⅲ评分(药物开期、关期)的差异均无统计学意义(均P>0.05)。与T2WI序列比较,3D-FLAIR上STN与周边白质的对比度更高(分别为0.48±0.10、0.34±0.11,t=-4.49,P=0.001)。两组比较,DBS电极植入的径向误差、STN-DBS开机6个月后的UPDRS-Ⅲ评分(药物关期)及其改善率的差异均无统计学意义(均P>0.05)。结论术前基于MRI定位STN靶点,采用3D-FLAIR与T2WI序列相比,两组患者DBS术后的电极植入精度与临床疗效相当;但3D-FLAIR显示STN与周边白质的对比度更高,更易识别。
Objective e To explore the clinical effect of 3D-FLAIR MRI sequence for targeting the subthalamic nucleus(STN)used in the deep brain stimulation(DBS)for the treatment of Parkinson's disease(PD).Methods A prospective study was conducted on 40 PD patients who underwent bilateral DBS surgery at the Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University from March 2021 to September 2022.According to simple randomization method,20 patients received T2-weighted image(T2WI)scan to target STN(T2WI group),while the other 20 patients underwent 3D-FLAIR sequence(3D-FLAIR group)scan.The contrast ratio of the STN and its surrounding normal white matter as well as the radial error on the plane parallel to anterior commissure-posterior commissure(AC-PC)plane after electrode implantation were calculated.The baseline data before surgery,the contrast ratio,the score of partⅢof Unified Parkinson's Disease Rating Scale(UPDRS-Ⅲ)after 6 months of surgery and its improvement rate were compared between the two groups.Results There were no significant difference in the gender,surgical age,disease duration,pre-surgical UPDRS-Ⅲscore(Med-on,Med-off)between the two groups(all P>0.05).The contrast ratio of STN and its surrounding normal white matter was higher in 3D-FLAIR group than that in T2WI group(0.48±0.10 vs.0.34±0.11,t=-4.49,P=0.001).In the radial error of implanted electrodes,the UPDRSⅢscore(Med-off)or motor score improvement rate at 6 months post turning on of the stimulator,there were no significant differences between the two groups(all P>0.05).Conclusion In pre-surgical localization of the STN on MRI,the electrode implantation accuracy and clinical efficacy after DBS of the 3D-FLAIR and T2WI groups were comparable,but the contrast between STN and the surrounding white matter was higher and the STN was easier to identify by 3DFLAIR.
作者
朱敏伟
王旭东
其力格尔
沈红
刘利
Zhu Minwei;Wang Xudong;Qiliger;Shen Hong;Liu Li(Department of Neurosurgery,the First Affliated Hospital of Harbin Medical University,Harbin 15001,China;Department of Neurology,the First Afiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2024年第1期46-49,共4页
Chinese Journal of Neurosurgery
基金
黑龙江省自然科学基金(LH2023H026)。
