上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (9): 1239-.doi: 10.3969/j.issn.1674-8115.2017.09.009

• 论著（临床研究） • 上一篇    下一篇

CT和MRI图像配准融合联合3D打印技术在难治性骨盆肿瘤 术前规划中的应用#br#

曲扬 1，艾松涛 1#，杨飞 2#，张恒辉 2，汪轶平 3，陶晓峰 1，郝永强 2，戴尅戎 2   

  1. 上海交通大学 1. 医学院附属第九人民医院放射科，上海 200011；2. 医学院附属第九人民医院骨科，上海市骨科内植物重点实验室，上海 200011；3. 机械与动力工程学院，生物医学制造与生命工程质量工程研究所，上海 200240
  • 出版日期:2017-09-28 发布日期:2017-10-10
  • 通讯作者: 艾松涛，电子信箱：ai.songtao@qq.com。杨 飞，电子信箱：feiyangyn@163.com。# 为共同通信作者
  • 作者简介:曲扬（1991—），男，硕士生；电子信箱：qyquyang@126.com
  • 基金资助:
     国家自然科学青年基金（81301260）；上海市教育委员会高峰高原学科建设计划（20152221）；上海市浦江人才计划 (15PJD025)；上海交通大学医学 院Ⅳ类高峰学科项目（GXQ08）；上海市第九人民医院临床研究助力计划（JYLJ025）

Application of CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors#br#

QU Yang1, AI Song-tao1#, YANG Fei2#, ZHANG Heng-hui2, WANG Yi-ping3, TAO Xiao-feng1, HAO Yong-qiang2, DAI Ke-rong2   

  1. 1. Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; 2. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China;
     3. Institute of Biomedical Manufacturing and Life Quality Engineering, Shanghai Jiao Tong University School of Mechanical Engineering, Shanghai 200240, China
  • Online:2017-09-28 Published:2017-10-10
  • Supported by:
     National Natural Science Foundation of China, 81301260; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152221; Shanghai Pujiang Program, 15PJD025; Shanghai Jiao Tong University School of Medicine Ⅳ Class Peak Discipline Project, GXQ08; Clinical Research Program of Shanghai Ninth People’s Hospital, JYLJ025

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摘要： 目的 · 探讨CT、MRI 图像配准融合联合3D 打印技术，在辅助难治性骨盆肿瘤术前规划中的应用价值。方法 · 回顾性总结 2014 年 3 月至 2016 年 12 月于上海交通大学医学院附属第九人民医院接受治疗的难治性骨盆肿瘤病例，术前常规行薄层CT、MRI 检 查，借助Medraw 软件实现CT、MRI 图像快速配准融合，精确判定肿瘤安全边界，辅助设计并3D 打印个体骨盆肿瘤模型、假体和 （或）导板。结果 · 共纳入难治性骨盆肿瘤患者 13 例（软骨肉瘤 8 例、骨肉瘤合并动脉瘤样骨囊肿 1 例、未分化性肉瘤 1 例、纤维结 缔组织增生性纤维瘤 1 例、孤立性纤维瘤 / 血管外皮瘤 1 例、转移性鳞癌 1 例），平均年龄（50.0±8.5）岁。基于 Enneking 分区：Ⅰ区 2 例、Ⅰ + Ⅱ区 2 例、Ⅱ + Ⅲ区 1 例、Ⅰ + Ⅱ + Ⅲ区 3 例、Ⅰ + Ⅱ + Ⅳ区 1 例、Ⅰ + Ⅱ + Ⅲ + Ⅳ区 1 例、Ⅰ + Ⅳ区 1 例、Ⅱ + Ⅳ区 1 例、Ⅳ区 1 例。肿瘤最大直径平均值（15.15±4.81）cm，均未累及盆腔大血管。结合术中肿瘤边界快速冰冻结果及假体安装情况，判 断基于融合图像的术前评估、规划的虚拟手术方案与手术的实施一致。结论 · 薄层 CT、MRI 图像配准融合联合 3D 打印技术，可以精 确判定难治性骨盆肿瘤边界，辅助临床设计个体化 3D 打印假体和导板，在难治性骨盆肿瘤术前规划中具有重要的临床应用价值。

关键词: 磁共振成像, 图像配准, 图像融合, 3D 打印, 骨盆肿瘤, 术前规划

Abstract:

Objective · To explore the value of applying CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors.  Methods · A retrospective analysis was performed on the cases with refractory pelvic tumors admitted between March 2014 and December 2016 in Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. CT/MRI examinations were performed as a routine pre-surgical procedure, and the resulting images were subject to rapid registration and fusion with the Medraw software in order to accurately determine the tumor boundaries and to be used as references in designing and making patient-specific tumor models, prostheses, and implants by 3D printing technique.  Results · A total of 13 cases with refractory pelvic tumors were included in this study (8 cases of chondrosarcoma, 1 case of osteosarcoma with aneurysmal bone cyst, 1 case of dedifferentiated sarcoma, 1 case of fibrous connective tissue hyperplasia, 1 case of solitary fibrous tumor/hemangiopericytoma, and 1 case of metastatic squamous cell carcinoma) with an average age of (50.0±8.5) years. According to the Enneking classification，there were 2 cases in zone Ⅰ , 2 in zones Ⅰ + Ⅱ , 1 in zones Ⅱ + Ⅲ , 3 in zones Ⅰ + Ⅱ + Ⅲ , 1 in zones Ⅰ + Ⅱ + Ⅳ , 1 in zones Ⅰ+Ⅱ+Ⅲ+Ⅳ, 1 in zones Ⅰ+Ⅳ, 1 in zones Ⅱ+Ⅳ, and 1 in zone Ⅳ . The mean maximal tumor diameter was (15.15±4.81) cm without implicating the pelvic blood vessels. Results from intraoperative frozen section at resection boundaries and the installation of prosthesis showed that the actual surgical procedure was consistent with the surgical planning based on the reported image fusion technique.  Conclusion · CT/MRI image registration and fusion technique combined with 3D printing technique can accurately determine the resection boundary of pelvic tumors and assist in designing of individualized prosthesis model and surgical guide, which has a great value in pre-surgical planning and clinical treatment of refractory pelvic tumors.

Key words: magnetic resonance imaging, image registration, image fusion, 3D printing, pelvic tumor, pre-surgical planning