Lead-DBS多模态影像融合技术在丘脑底核脑深部电刺激中的应用研究
周金山 梁立志 束汉生 辛 玲 代 凤 罗 宏 胡元亮 王大巍
蚌埠医学院第二附属医院，安徽 蚌埠 233000
通信作者：王大巍
【摘要】 目的 探讨 Lead-DBS 多模态影像融合技术在丘脑底核脑深部电刺激中的应用价值。方法 纳入 60 例帕金森病（PD）患者均进行双侧丘脑底核（STN）脑深部电刺激术（DBS），将患者分为 2 组，融合组与对照组均为 30 例。融合组在 Lead-DBS 融合图像辅助下实施开机程控策略，对照组进行传统的逐个触点尝试的程控策略，统计 2 组患者开机耗时、开机后 3 个月来程控次数、不良反应次数及 UPDRS-Ⅲ改善率，统计术后 3 个月组织激活体积（VTA）与丘脑底核（STN）重叠部分占 STN 的百分比及 UPDRS-Ⅲ评分改善率、PD 生活质量问卷（PDQ-39）评分改善率及术后非运动症状评分（NMSS）改善率。结果 纳入 60 例病人并全部接受随访 3 个月。患者年龄、性别等基线资料差异无统计学意义（P＞0.05），融合组首次开机程控时为（103.83±12.21）min，对照组开机耗时（160.20±15.47）min，P＜0.05；融合组开机程控不良反应次数平均为 1.63 次，而对照组平均出现 2.47 次，差异均具有统计学意义（P＜0.05）。术后 3 个月人均程控次数融合组为（4.33±1.40）次，对照组为（4.97±1.13）次，开机后 UPDRS-Ⅲ改善率融合组与对照组相比，差异均无统计学意义（P＞0.05）。术后 3 个月均进行影像融合，所有患者 VTA 与 STN 重叠部分占STN 的百分比与 UPDRS-Ⅲ评分改善率、PDQ-39 改善率及非运动症状改善率呈正相关，相关系数分别为r＝0.66、r=0.47、r＝0.28。 结论 Lead-DBS 多模态影像融合技术辅助术后首次开机程控，可减少首次开机耗时，减少程控次数，提高程控效率，为术后程控提供一种新的思路，同时在评估预后方面具有重要临床意义。
【关键词】 脑深部电刺激术；多模态影像融合；丘脑底核；组织激活体积；程控
【中图分类号】 R743 【文献标识码】 A 【文章编号】 1673-5110 （2022） 06-0691-08
基金项目：2021 年安徽高校自然科学研究重点项目 （编号：KJ2021A0786）；2021 年蚌埠医学院科技项目自然重点 （编号：2021byzd281sk）
DOI：10.12083/SYSJ.220235
Application of lead DBS multimodal image fusion technology in deep subthalamic nucleus stimulation
ZHOU Jinshan，LIANG Lizhi，SHU Hansheng，XIN Ling，DAI Feng，LUO hong，HU Yuanliang WANG Dawei
The Second Affiliated Hospital of Bengbu Medical College，Bengbu 233000 China
Corresponding author：Wang Dawei
【Abstract】 Objective To explore the application value of Lead-DBS multimodal image fusion technology in deep subthalamic nucleus stimulation. Methods Sixty patients with Parkinson’s disease（PD）underwent bilateral subthalamic nucleus（STN）deep brain stimulation（DBS）. The patients were divided into two groups，30 cases in the fusion group and control group. The fusion group implemented the start-up program control strategy with the help of lead DBS fusion image，and the control group carried out the traditional program control strategy of trying one contact by one. The start-up time，program control times，adverse reactions and UPDRS-Ⅲ improvement rate of patients in the two groups were counted，The percentage of overlap between tissue activation volume（VTA）and subthalamic nucleus（STN）in STN，the improvement rate of UPDRS -Ⅲ score，the improvement rate of PD quality of life questionnaire（PDQ-39）score and the improvement rate of postoperative non-motor symptom score（NMSs）were counted 3 months after operation. Results All 60 patients were followed up for 3 months. There was no significant difference in baseline data such as age，gender and disease stage（P>0.05）.The first start-up program control time in the fusion group was（103.83±12.21）min，and the start-up time in the control group was（160.20±15.47）min，P<0.05; The average number of programmed adverse reactions in the fusion group was 1.63，while that in the control group was 2.47（P<0.05）. Three months after operation，the number of programmed times per capita in the fusion group was（4.33±1.40）times and that in the control group was（4.97±1.13）. There was no significant difference in the improvement rate of UPDRS-Ⅲ between the fusion group and the control group（P＞0.05）. Three months after operation，all patients underwent image fusion. The percentage of overlap between VTA and STN in STN was positively correlated with the improvement rate of UP⁃DRS-Ⅲ score，PDQ-39 and non-motor symptoms. The correlation coefficients were r=0.66，r=0.47 and r=0.28 respectively. Conclusion Lead DBS multimodal image fusion technology assisted in the program control of the first startup after operation can reduce the time-consuming of the first startup，reduce the number of program control，improve the program control efficiency，provide a new idea for the program control after operation，and has important clinical significance in evaluating the prognosis.
【Key words】 Deep brain stimulation；Multimodal image fusion；subthalamic nucleus；Volume of the tissue activated；program control
