磁共振弥散张量成像联合纤维束示踪成像对前列腺根治术前前列腺周围神经三维显像的初步探索

doi:10.19558/j.cnki.10-1020/r.2022.05.005

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摘要 目的：评估盆腔磁共振弥散张量成像（DTI）联合纤维束示踪成像（DTT）与T2WI图像、三维器官融合重建对于前列腺周围神经显像的效果,探讨对行前列腺根治性切除术患者前列腺周围神经保护的价值。方法：纳入15例行盆腔磁共振平扫及增强扫描（包括T1WI、T2WI、DWI、DTI、T1 LAVA Flex Dynamic phase序列）,并行前列腺穿刺活检明确病理为前列腺癌的患者,通过DTI联合DTT技术,对前列腺周围神经进行追踪显像,并与T2WI图像、三维重建器官进行融合,显示前列腺周围神经的走行和与盆腔脏器的关系。比较患者术前和术后尿控功能及性功能的差异。结果：15例前列腺癌患者行前列腺周围神经三维追踪显像,其中4例因原始图像质量不佳予以排除,其余11例图像质量优良,清晰追踪并显示前列腺周围神经走行和与盆腔脏器关系。患者尿控功能在术后6月基本恢复术前水平,差异无统计学意义（P=0.165）,术后6月性功能相比术前较差,差异具有统计学意义（P=0.028）。结论：盆腔磁共振DTI联合DTT技术可以清晰追踪显示前列腺周围神经走行,通过融合T2WI图像、三维器官重建图像,显示神经与盆腔脏器的关系,对于术中前列腺周围神经的保护具有一定应用价值。

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关键词 ：前列腺肿瘤, 弥散磁共振成像, 弥散张量成像

Abstract：Objective： To evaluate the effect of three-dimensional reconstruction on periprostatic nerve fibers imaging using pelvic magnetic resonance diffusion tensor imaging （DTI） with diffusion tensor tractography （DTT） fused with T2WI images and organ reconstruction images, and to investigate the value of periprostatic nerve protection in patients undergoing radical prostatectomy. Methods： A total of 15 patients with pelvic MRI plain and enhanced scans （including T1WI, T2WI, DWI, DTI, T1 LAVA Flex dynamic phase sequences） and biopsy-proven prostate cancer were included, and the periprostatic nerve was traced and visualized by DTI with DTT technique, and images were fused with T2WI images and 3D reconstruction images of the organ to show the path of the periprostatic nerve fibers and its relationship with the pelvic organs. The differences in urination and erectile function before and after operation were compared. Results： Of the 15 patients with prostate cancer who underwent three-dimensional periprostatic nerve fibers tracing reconstruction, 4 patients were excluded due to poor quality of the original images, while the remaining 11 patients had excellent image quality and clearly traced and showed the periprostatic nerve path and relationship with the pelvic organs. At 6th month after operation, the urination function of the patients basically recovered to the preoperative level, and the difference was not statistically significant （P=0.165）. The erectile function of patients at 6th month after operation was worse, and the difference was statistically significant （P=0.028）. Conclusion： The pelvic MRI DTI combined with DTT technique can clearly track the periprostatic nerve and show the relationship between the nerve fibers and pelvic organs by fusing T2WI images and 3D organ reconstruction images, which is valuable for the intraoperative protection of the periprostatic nerve.

Key words： prostate tumors diffusion magnetic resonance imaging diffusion tensor tractography

收稿日期: 2022-09-03

通讯作者: 张旭,xzhang301@163.com

引用本文:

陈科, 贾卓, 吕香君, 敖砾言, 任昶澔, 许云来, 张晓晶, 王海屹, 王保军, 马鑫, 张旭. 磁共振弥散张量成像联合纤维束示踪成像对前列腺根治术前前列腺周围神经三维显像的初步探索[J]. 微创泌尿外科杂志, 2022, 11(5): 311-316.
Chen Ke, Jia Zhuo, Lü Xiangjun, Ao Liyan, Ren Changhao, Xu Yunlai, Zhang Xiaojing, Wang Haiyi, Wang Baojun, Ma Xin, Zhang Xu. Three-dimensional visualization of the periprostatic nerve fibers using magnetic resonance diffusion tensor imaging with diffusion tensor tractography before radical prostatectomy: a preliminary study. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(5): 311-316.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1796.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2022/V11/I5/311

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