摘要
目的分析3.0 T磁共振(MRI)兼容脑深部电刺激(DBS)系统在帕金森病(PD)丘脑底核(STN)刺激术后早期的影像学改变及其对电极阻抗的影响。方法回顾性分析2022年10月至2023年4月在中国科学技术大学附属第一医院(安徽省立医院)进行3.0 T MRI兼容DBS系统STN-DBS手术治疗的43例PD患者资料,男27例,女16例,年龄43~68(56±5)岁。所有患者进行了术后1周头部3.0 T MRI、头部CT扫描和阻抗测定,15例患者在术后1个月进行了头部3.0 T MRI和阻抗测定,比较3.0 T MRI扫描前后电极触点阻抗值的差异,并且分析患者术后电极周边水肿(PLE)的发生情况,比较两种成像在PLE检出率的差别;比较不同微电极记录(MER)次数、不同时间节点的PLE差异;并分析电极阻抗与核团周边水肿(SE)体积的相关性。结果43例患者均成功完成手术,共植入86根电极,术后1周和1个月行3.0 T MRI检查前后的电极阻抗值差异无统计学意义;3.0 T MRI的PLE的检出率为95.12%(39/43),显著高于CT成像的17.07%(7/43)(χ^(2)=50.705,P<0.001);术后1周,与单次MER组相比,多次MER组PLE的发生率和体积差异无统计学意义;术后1个月时PLE体积[M(Q_(1),Q_(3)),0(0,1.211)cm^(3)]与1周[0.243(0,2.914)cm^(3)]相比显著缩小(Z=-3.408,P=0.001);术后1个月内电极触点阻抗呈先降低后升高的趋势,且与SE体积呈负相关(r=-0.317,P=0.014)。结论3.0 T MRI兼容DBS设备应用于PD患者的DBS手术治疗,提升了患者术后早期的影像评估准确性;术后1个月时随着核团周边水肿的消退电极阻抗更稳定,适合首次程控。
Objective To analyze the imaging changes of in the early period after subthalamic nucleus(STN)deep brain stimulation(DBS)surgery for Parkinson′s disease(PD)and its impact on electrode impedance by the application of 3.0T MRI-compatible devices.Methods A retrospective analysis was performed for the data of 43 PD patients who underwent 3.0T MRI-compatible STN-DBS surgery from October 2022 to April 2023 at the First Affiliated Hospital of USTC(Anhui Provincial Hospital),including 27 males and 16 females,aged 43-68(56±5)years.All patients underwent postoperative 3.0T MRI,CT scans,and impedance measurements 1 week postoperatively.Fifteen patients underwent 3.0T MRI and impedance measurements 1 month postoperatively.The differences in impedance of electrode contacts before and after the 3.0T MRI scans were compared.The occurrence of peri-lead cerebral edema(PLE)in patients was analyzed,as well as the differences in PLE detection rates between the two imaging methods,and the differences in the incidence and volume of PLE at different microelectrode recordings,the occurrence and detection of postoperative PLE,and different microelectrode recording(MER)times and different time nodes were compared.The correlation between electrode impedance and the volume of edema around the nucleus was analyzed.Results All 43 patients successfully underwent surgery,with a total of 86 electrodes implanted.There was no significant difference in electrode impedance values before and after the 3.0T MRI examinations at 1 week and 1 month postoperatively.The PLE detection rate with 3.0T MRI was 95.12%(39/43),which is significantly higher than that of CT imaging 17.07%(7/43)(χ^(2)=50.705,P<0.001).One week after surgery,the incidence and volume of PLE were higher in the multiple MER group compared with the single MER group,but the difference was not statistically significant.The volume of PLE[M(Q_(1),Q_(3))0(0,1.211)cm^(3)]at 1 month was significantly smaller than that at 1 week[0.243(0,2.914)cm^(3)](Z=-3.408,P=0.001).The impedance of electrode contacts within 1 month postoperatively showed a trend of initial decrease followed by an increase,which was negatively correlated with SE volume(r=-0.317,P=0.014).Conclusions The application of 3.0T MRI-compatible DBS devices in the surgical treatment of PD patients improves the accuracy of early postoperative imaging assessment.The electrode impedance is more stable as the edema around the nucleus subsided at 1 month after surgery,which is suitable for the first program control.
作者
熊赤
陈鹏
蒋曼丽
常博文
牛朝诗
Xiong Chi;Chen Peng;Jiang Manli;Chang Bowen;Niu Chaoshi(Department of Neurosurgery,the First Affiliated Hospital of USTC,Division of Life Sciences andMedicine,University of Science and Technology of China,Anhui Provincial Key Laboratory of Brain Function and Disease,Hefei 230001,China;Department of Neuroelectrophysiology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230036,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第47期3809-3815,共7页
National Medical Journal of China
基金
安徽省医疗卫生重点专科建设项目[皖卫函(2021)273号]
安徽省高校优秀科研创新团队项目(2023AH010080)
关键词
帕金森病
脑深部电刺激
3.0
T核磁兼容
电极周边水肿
电极阻抗
随访研究
Parkinson′s disease
Deep brain stimulation
3.0 T MRI compatibility
Peri-lead cerebral edema
Electrode impedance
Follow-up studies
