本文選題：內囊 + 斷層影像解剖��； 參考：《蚌埠醫(yī)學院》2014年碩士論文

【摘要】：研究背景：隨著腦立體定向技術、腦功能成像技術、X-刀、γ-刀技術、微創(chuàng)神經外科技術以及分子生物學技術的發(fā)展和進步，功能神經外科立體定向技術、微創(chuàng)神經外科立體定向技術等需求越來越多，因此在大腦薄層MRI圖像上對腦實質區(qū)域的形態(tài)學、三維空間定位及三維可視化進行深入細致的研究，為腦內微小占位性病變進行精確的定位，準確的擬定術前手術方案、精確術中手術實施操作方案提供重要幫助。 首先提出內囊（internal capsule）這一名詞的是Burdach，它是白質板，位于尾狀核、豆狀核和背側丘腦之間。在橫斷面上，似向外開放的“V”字形，分三部即前肢、后肢和膝部。前肢（又稱額部）在尾狀核和豆狀核之間，向前外方向走形。后肢（又稱枕部）向后外方向走形，又分為豆狀核后部、豆丘部（豆狀核與背側丘腦之間）和豆狀核下部三部分。膝部位于前肢和后肢之間，即“V”字形的交角處。內囊是大腦皮層與大腦皮層下的上行、下行纖維經過的區(qū)域。累計內囊的病損比大腦其他區(qū)域的病損造成的傷殘更為廣泛。并且在CT和MRI診斷中，內囊區(qū)域的臨床意義也很重要。 內囊的研究無論是在國內還是國外，主要是關于其結構破壞及功能障礙，而且除了關于內囊基本結構外，還缺乏整體形態(tài)學研究。因此，對內囊在斷面上的形態(tài)進行詳細的描述，研究內囊在斷面上的非對稱性，構建內囊的三維立體定位數據集和三維可視化模型，對于微創(chuàng)神經外科學、醫(yī)學影像學等提供解剖學資料。 本研究是以大腦連合間徑線的中點作為原點、前連合與后連合的間徑作為Y軸建立起笛卡爾三維坐標系。通過對30例中國健康成人大腦內囊薄層MRI圖像的研究，找到內囊在橫斷面上的形態(tài)特征規(guī)律；建立關于內囊的外側邊緣及內側邊緣立體定位數據集，分析其在坐標系中的投影圖及回歸方程；分析內囊的非對稱性；重建內囊在大腦中的可視化模型。為功能神經外科立體定向、放射外科立體定向及微創(chuàng)神經外科和研究內囊的發(fā)育及其結構與功能的關系提供解剖學基礎。 第一部分：基于前后連合間徑定位體系的大腦內囊斷層影像解剖學 目的：通過研究以基于AC-PC間線為掃描基線的活體薄層MRI圖像，總結大腦內囊在水平切面上的形態(tài)學特征及位置變化規(guī)律； 方法：30名健康的成年志愿者，以大腦連合間徑線為掃描基線行顱腦橫斷層薄層2mm MRI掃描。在微型計算機上將掃描得到的數據以Dicom3.0的格式導入eFilm2.1工作站。使用“3D-Cursor”技術來識別大腦內囊區(qū)域，觀測、統(tǒng)計其形態(tài)特征。 結果：識別出在三維薄層MRI圖像連續(xù)層面上的內囊，并且總結出內囊的形態(tài)及位置變化規(guī)律。 結論：使用“3D-Cursor”技術對照容易識別的冠狀面，能夠準確識別在橫斷面薄層MRI圖像連續(xù)層面上的內囊，為基底節(jié)區(qū)的病灶定位提供解剖學基礎。內囊連續(xù)層面的識別分析為臨床影像診斷學和大腦的發(fā)生發(fā)育學提供參考依據。 第二部分：內囊內側緣及外側緣立體定位數據集的構建及投影回歸分析 目的：構建內囊內側邊緣及外側邊緣在基于連合間徑定位體系中的立體定位數據集；得出內囊在橫、矢狀面和冠狀面的投影圖；求出內囊內外側邊緣的回歸方程。 方法：將30名健康的成年志愿者顱腦橫斷層MRI圖像數據以JPG格式導出并保存，然后再導入Photoshop軟件，圖像經過嚴格配準，使基于連合間徑的笛卡爾三維坐標系的原點、X軸、Y軸與軟件自身的坐標體系重合。分別測量并且記錄內囊內側邊緣及外側邊緣的坐標值X、Y值，Z值即為所在層面距離AC-PC平面的層數與層厚的乘積，，所有采樣點的坐標值構成內囊在三維坐標系中的立體定位數據集；使用30名志愿者已經獲得的數據，在SPSS軟件內完成橫、矢狀面和冠狀面的投影圖；采用SPSS17.0軟件得出內囊在各投影方向的回歸方程。結果：構建出正常成年男性及女性內囊內外側邊緣在三維坐標系中的立體定位數據集；統(tǒng)計繪制了橫、矢狀面和冠狀面的投影圖；得出了內囊內外側邊緣在各投影平面上的回歸方程。 結論：內囊在基于連合間徑定位體系中的立體定位數據集的構建，橫、矢狀面和冠狀面的投影圖以及回歸方程的繪制分析，對于應用立體定向技術及功能神經外科學提供解剖學基礎；對于揭示大腦深部區(qū)域的發(fā)生、發(fā)育等形態(tài)學規(guī)律同樣具有重要的意義。 第三部分：內囊的非對稱性研究 目的：觀測、分析內囊是否存在性別和側別的非對稱性。 方法：在微型計算機中使用eFilm工作站，我們選擇了30例正常人，男15例，女15例，顱腦橫斷面MRI圖像，選擇其中內囊出現的層面，將圖像導入Photoshop軟件中來測量，進而得出內囊區(qū)男、女性左右兩側距正中矢狀面的距離，經SPSS17.0軟件統(tǒng)計得出男、女性左右兩側距離差異。 結果：統(tǒng)計了男、女性兩側內囊在水平面上的映射側別差異及性別差異。 結論：男、女性左右兩側內囊在水平面上的映射關系，是否可以表述為相同性別國人群體兩側內囊以正中矢狀面呈“鏡像對稱”，不同性別國人群體兩側內囊男性較女性大。 第四部分：大腦內囊的三維重建與可視化 目的：為內囊及鄰近周邊區(qū)域結構的立體定位、放射立體定向、微創(chuàng)神經外科立體定向以及解剖學教學等提供三維可視化模型。 方法：在微型計算機上，正常成人5名（沒有神經、精神病史及家族史）大腦橫斷層2mm薄層MRI圖像掃描數據以Dicom3.0的格式導入3D-Doctor軟件，手動分割內囊、基底核區(qū)、側腦室、腦的表面等感興趣區(qū)，分別用不同的色彩標記，以復雜表面重建方法三維重建上述各個結構。 結果：成功重建了內囊、基底核區(qū)及側腦室在大腦中的三維可視化模型，可以任意方位對模型進行旋轉，從各個角度再現了內囊、基底核區(qū)及側腦室的三維模型、在大腦中的空間位置以及它們相互之間的位置關系。 結論：內囊的三維可視化模型展現了內囊在活體腦中的三維空間結構及毗鄰關系，為腦內占位性病變的重建和觀測，提供了重要的方法。對立體定向神經外科手術入路的制定、介入放射科放療計劃的實施以及醫(yī)學教學具有重要的價值。
[Abstract]:Background: with brain stereotactic, brain functional imaging, X- knife, gamma knife, minimally invasive Department of neurosurgery and molecular biology, more and more needs are needed in the functional department of Neurosurgery stereotactic technology and minimally invasive stereotactic technology. Therefore, the brain parenchyma area is on the brain thin layer MRI images. The morphological, three-dimensional and three-dimensional visualization of the domain are studied in detail, which can accurately locate the small space occupying lesions in the brain, accurately formulate the preoperative operation scheme, and provide important help for the operation of the precise operation.
First, the term internal capsule is called Burdach, which is a white matter plate between the caudate nucleus, the lenticular nucleus and the dorsal thalamus. On the cross section, it resembles an outward "V" shape, divided into three parts, the forelimbs, the hind limbs and the knee. The forelimb (also called the forehead) is between the caudate nucleus and the lenticular nucleus, in the forward direction. (also called the pillow), the hind limbs (also called the pillow) In the back direction, it is divided into the rear of the bean shaped nucleus, the bean hillock (the bean nucleus and the dorsal thalamus) and the lower part of the bean nucleus. The knee is located between the forelimb and the hind limbs, between the forelimb and the hind limbs, the intersection of the "V" shape. The inner capsule is the upper part of the cerebral cortex and the cerebral cortex, and the area of the downlink fiber dimension. The cumulative damage of the internal capsule is more than the rest of the brain. The damage caused by lesions is more extensive. In the diagnosis of CT and MRI, the clinical significance of the internal capsule area is also important.
The study of internal capsule is mainly about structural damage and dysfunction. Besides the basic structure of internal capsule, there is still a lack of overall morphological study. Therefore, the morphology of the internal capsule on the cross section is described in detail, the asymmetry of the internal capsule on the section is studied, and the three-dimensional positioning number of the internal capsule is constructed. According to the set and 3D visualization model, we provide anatomical data for minimally invasive Department of Neurosurgery, medical imaging and so on.
This study is based on the middle point of the cerebral commissure diameter line as the origin, the diameter of the anterior commissure and the posterior commissure is used as the Y axis to establish the Cartesian three-dimensional coordinate system. Through the study of the thin layer MRI image of the internal capsule of the brain of 30 healthy adults in China, the morphological characteristics of the inner sac in the cross section are found, and the outer edge and the inner edge of the inner capsule are established. The projection and regression equations in the coordinate system were analyzed, the asymmetry of the internal capsule and the reconstruction of the internal capsule in the brain were analyzed. The relationship between the three-dimensional orientation of the functional department of Neurosurgery, the radiosurgery stereotactic and the development of the minimally invasive Department of neurosurgery and the study of the internal capsule and the structure and function of the internal capsule were provided. The basis of learning.
Part I: sectional anatomy of the internal capsule of the brain based on the anterior and posterior commissure diameter positioning system.
Objective: To summarize the morphological features and position changes of the cerebral internal capsule on the horizontal section of the brain by studying the thin layer MRI images based on the AC-PC line as the scanning baseline.
Methods: 30 healthy adult volunteers were scanned with the 2mm MRI scan on the brain transverse fault line as the baseline of the cerebral commissure line. The data scanned on the microcomputer were introduced into the eFilm2.1 workstation in the format of Dicom3.0. "3D-Cursor" technique was used to identify the internal capsule area of the brain, and the morphological characteristics were observed.
Results: the internal capsule was identified at the continuous level of three-dimensional thin slice MRI images, and the morphology and location of the internal capsule were summarized.
Conclusion: using the "3D-Cursor" technique to compare the easily identified coronal plane, it can identify the internal capsule on the continuous layer of the cross section thin layer MRI image accurately, and provide anatomic basis for the location of the basal ganglia, and the recognition analysis of the inner capsule continuous layer provides the reference for the clinical imaging diagnosis and the development of the brain.
The second part: Stereotactic data set and projection regression analysis of medial margin and lateral margin of internal capsule.
Objective: to construct a stereoscopic positioning data set on the medial and lateral edge of the internal capsule in the system based on the junction diameter, and to obtain the projection of the internal capsule in the transverse, sagittal and coronal surfaces, and to find the regression equation of the inner and outer side of the inner capsule.
Methods: the MRI image data of 30 healthy adult volunteers were derived and preserved in JPG format and then imported into Photoshop software. The images were strictly registered, and the origin of Descartes three-dimensional coordinate system based on the coupling diameter, the X axis and the Y axis were coincided with the software itself, and the inner side of the inner capsule was measured and recorded respectively. The coordinate value X, Y value and Z value of the edge and the outer edge are the product of the layer and thickness of the AC-PC plane at the level of the plane, and the coordinate values of all the sampling points constitute the stereoscopic positioning data set of the inner capsule in the three-dimensional coordinate system; using the data obtained by 30 volunteers, the projection of the transverse, sagittal and coronal surfaces in the SPSS software is completed; The regression equation of the internal capsule in each projection direction was obtained by using the SPSS17.0 software. Results: the stereoscopic positioning data set in the three-dimensional coordinate system of the inner and outer sides of the normal adult male and female inner capsule was constructed, and the projection diagram of the transverse, sagittal and coronal surfaces was drawn, and the regression equation of the inner and outer side of the inner capsule on the projection planes was obtained.
Conclusion: the construction of the stereotaxic data set, the projection of the transverse, the sagittal plane and the coronal plane and the regression equation are drawn and analyzed in the internal capsule, which are based on the joint diameter positioning system, and provide the anatomical basis for the application of stereotactic technology and functional department of Neurosurgery; it also reveals the morphological rules of the occurrence and development of the deep region of the large brain. It is also of great significance.
The third part: the study of the asymmetry of internal capsule
Objective: To observe the presence of sex and lateral asymmetry in the internal capsule.
Methods: using a eFilm workstation in a microcomputer, we selected 30 normal people, 15 men, 15 women, 15 cases and MRI images of the craniocerebral cross section. We selected the internal capsule level and introduced the image into the Photoshop software to measure the distance between the inner capsule area men and the female left and right sides of the median sagittal plane, and the SPSS17.0 software was used to calculate the distance. Men, women on both sides of the distance difference.
Results: the lateral differences and gender differences between the two sides of the internal capsule in male and female were statistically analyzed.
Conclusion: the mapping relationship between the two sides of the inner capsule on both sides of the male and the female can be expressed as a mirror symmetry in the median sagittal face of the two sides of a homosexual group of people, and the male of different sexes is larger than the female.
The fourth part: 3D reconstruction and visualization of the internal capsule of the brain.
Objective: to provide three-dimensional visualization model for the three-dimensional positioning of the inner capsule and adjacent region, the stereotactic radiological orientation, the three-dimensional orientation of the minimally invasive Department of neurosurgery and the teaching of anatomy.
Methods: on the microcomputer, 5 normal adults (without nerve, mental illness history and family history) the scanning data of the 2mm thin layer MRI image of the cerebral transverse fault were introduced into the 3D-Doctor software in the format of Dicom3.0, and the intrications of the inner capsule, the basal nucleus area, the lateral ventricle and the surface of the brain were manually divided, and the different color markers were used for the complex surface reconstruction. Three dimensional reconstruction of the above structures.
Results: the three-dimensional visualization model of the inner capsule, basal nucleus and lateral ventricle in the brain was reconstructed successfully. The model can be rotated in any direction, and the three-dimensional model of the inner capsule, the basal nucleus and the lateral ventricle, the space position in the brain and the position relation of each other in the brain can be reproduced from various angles.
Conclusion: the three-dimensional visualization model of the internal capsule shows the three-dimensional spatial structure and adjacent relationship of the internal capsule in the living brain. It provides an important method for the reconstruction and observation of the occupying lesions in the brain. It is of great value to the formulation of the surgical approach in the stereotactic Department of Neurosurgery, the implementation of the interventional radiology radiotherapy plan and the medical teaching.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2

【參考文獻】

相關期刊論文 前10條

1 沈龍山;王震寰;張磊;張順花;張艷;張俊祥;劉志軍;;計算機輔助連續(xù)結構追蹤技術對大腦中央溝精確定位的方法學研究[J];蚌埠醫(yī)學院學報;2008年06期

2 沈龍山;王震寰;張磊;張順花;張艷;張俊祥;劉志軍;;計算機輔助三維定標法在冠、矢狀位MRI腦結構定位的研究[J];蚌埠醫(yī)學院學報;2008年06期

3 夏長麗;徐亮;徐佳;鞠維娜;樸慧烘;金仙梅;樸賢英;戴t;李幼瓊;;人腦內囊的三維重建及臨床應用[J];吉林大學學報(醫(yī)學版);2007年05期

4 張紹祥,劉正津,譚立文,邱明國,李七渝,李愷,崔高宇,郭燕麗,劉光久,單錦露,劉繼軍,張偉國,陳金華,王健,陳偉,陸明,游箭,龐學利,肖紅,許忠信,王欲u&,鄧俊輝,唐澤圣;首例中國女性數字化可視人體數據集完成[J];第三軍醫(yī)大學學報;2003年04期

5 秦媛;陳楠;朱凱;牛建棟;王一帆;王星;朱力;郭玉林;李坤成;;中國漢族成人內囊體積與年齡相關性研究[J];臨床放射學雜志;2012年01期

6 張海軍;林志國;王躍華;;中國人腦MRI立體定向活體尾狀核數字化的三維重建[J];中國組織工程研究與臨床康復;2009年09期

7 張季;王宜杰;;醫(yī)學圖像三維重建方法的比較研究[J];醫(yī)學信息;2006年06期

8 汪啟東;徐曉俊;張敏鳴;;兩側內囊非對稱性的磁共振彌散張量成像研究[J];浙江大學學報(醫(yī)學版);2008年05期

9 葉祥明;李厥寶;周亮;聞萬順;;急性腦卒中三偏征的早期康復效果觀察[J];中國康復理論與實踐;2010年06期

10 林支付,盧洪煊,沈宏,葛霽光;丘腦的計算機三維重建及其臨床意義[J];中國臨床解剖學雜志;2000年01期

本文編號：2028391