多模态三维影像融合技术体系的建立及在脑血管病诊疗中的应用

doi:10.3877/cma.j.issn.2095-123X.2023.03.001

多模态三维影像融合技术将两种或两种以上不同数字化三维影像成像数据（CT、MR、DSA等）输入后处理工作站，采用影像融合软件重建、解剖配准、图像融合，能够得到多种解剖结构的多模态三维融合影像，其中"影像融合"指的是融合技术，"融合影像"为融合结果。这种融合影像能更全面、精准地显示脑-脊髓血管病的毗邻解剖关系，有助于对脑-脊髓血管病的精准诊断并指导制定治疗方案，还可以进一步反馈回DSA系统、导航系统等直接指导手术，以达到提高手术疗效、降低手术风险的目的。本文围绕多模态三维影像融合技术体系的建立及在脑血管病诊疗中的应用作一述评。

关键词: 脑血管病, 三维影像融合, 显微外科手术, 介入神经外科

Multi-modal three-dimensional (3D) image fusion technology can obtain multi-modal 3D image fusion of various anatomical structures by inputting two or more different digital 3D image data (CT, MR, DSA, etc.) into a post-processing workstation and using image fusion software for reconstruction, anatomical registration and image fusion. Among them, "image fusion" refers to the fusion technology, and "fusion image" is the fusion result. This fusion image can more comprehensively and accurately display the adjacent anatomical relationship of cerebrospinal vascular disease, which is conducive to the accurate diagnosis of cerebrospinal vascular disease and guide treatment plans. It can also further feedback the DSA system and navigation system to directly guide surgical treatment, so as to improve surgical efficacy and reducing surgical risk. This article reviews the establishment of multi-mode 3D image fusion technology system and its application in diagnosis and treatment of cerebrovascular disease.

Key words: Cerebrovascular disease, Three-dimensional image fusion, Microsurgery, Interventional neurosurgery

图1 不同数据来源的影像导入工作站A：PICS系统中不同数据在解剖上存在很大的误差；B：采用手工操作，在3个轴位上进行解剖配准（颅骨融合）

Fig.1 Images from different data sources import workstation

图3 CT与3D-DSA融合以判断责任动脉瘤

Fig.3 Ascertaining responsible aneurysm by the fusion of CT and 3D-DSA images

图4 小容积采集显示颅内动脉支架A："小容积"采集的LEO支架影像与术前3D-DSA影像融合，显示支架贴壁良好；B：小视野采集显示的支架与3D血管融合影像，可见支架打折，贴壁不良

Fig.4 Intracranial arterial stent shown in the reduced field-of-view images

图5 双容积成像技术：将微弹簧圈影像（紫色）与3D血管像融合，可见动脉瘤与微弹簧圈的关系

Fig.5 Double volume imaging technique: the relation between aneurysms and microcoil can be observed by fusing the original images of microcoil (purple) and 3D images of vessels

图7 采用CTA和术前3D-DSA影像作为虚拟路图

Fig.7 Using CTA or preoperative 3D-DSA images as the virtual road map

图8 将DSA图像融入导航系统A：DSA示脉络膜后内侧动脉末段的动脉瘤；B：A图中的动脉瘤在MRI不能见，但在DSA三维重建图像可以看到，在导航系统中指导动脉瘤的定位

Fig.8 Fuse DSA images and navigation system

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Establishment of multi-mode three-dimensional image fusion technology system and its application in diagnosis and treatment of cerebrovascular disease

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Establishment of multi-mode three-dimensional image fusion technology system and its application in diagnosis and treatment of cerebrovascular disease