本文選題：內(nèi)囊 + 斷層影像解剖　； 參考：《蚌埠醫(yī)學(xué)院》2014年碩士論文

【摘要】：研究背景：隨著腦立體定向技術(shù)、腦功能成像技術(shù)、X-刀、γ-刀技術(shù)、微創(chuàng)神經(jīng)外科技術(shù)以及分子生物學(xué)技術(shù)的發(fā)展和進(jìn)步，功能神經(jīng)外科立體定向技術(shù)、微創(chuàng)神經(jīng)外科立體定向技術(shù)等需求越來(lái)越多，因此在大腦薄層MRI圖像上對(duì)腦實(shí)質(zhì)區(qū)域的形態(tài)學(xué)、三維空間定位及三維可視化進(jìn)行深入細(xì)致的研究，為腦內(nèi)微小占位性病變進(jìn)行精確的定位，準(zhǔn)確的擬定術(shù)前手術(shù)方案、精確術(shù)中手術(shù)實(shí)施操作方案提供重要幫助。 首先提出內(nèi)囊（internal capsule）這一名詞的是Burdach，它是白質(zhì)板，位于尾狀核、豆?fàn)詈撕捅硞?cè)丘腦之間。在橫斷面上，似向外開(kāi)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?fàn)詈酥g，向前外方向走形。后肢（又稱枕部）向后外方向走形，又分為豆?fàn)詈撕蟛俊⒍骨鸩浚ǘ範(fàn)詈伺c背側(cè)丘腦之間）和豆?fàn)詈讼虏咳糠�。膝部位于前肢和后肢之間，即“V”字形的交角處。內(nèi)囊是大腦皮層與大腦皮層下的上行、下行纖維經(jīng)過(guò)的區(qū)域。累計(jì)內(nèi)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(nèi)囊區(qū)域的臨床意義也很重要。 內(nèi)囊的研究無(wú)論是在國(guó)內(nèi)還是國(guó)外，主要是關(guān)于其結(jié)構(gòu)破壞及功能障礙，而且除了關(guān)于內(nèi)囊基本結(jié)構(gòu)外，還缺乏整體形態(tài)學(xué)研究。因此，對(duì)內(nèi)囊在斷面上的形態(tài)進(jìn)行詳細(xì)的描述，研究?jī)?nèi)囊在斷面上的非對(duì)稱性，構(gòu)建內(nèi)囊的三維立體定位數(shù)據(jù)集和三維可視化模型，對(duì)于微創(chuàng)神經(jīng)外科學(xué)、醫(yī)學(xué)影像學(xué)等提供解剖學(xué)資料。 本研究是以大腦連合間徑線的中點(diǎn)作為原點(diǎn)、前連合與后連合的間徑作為Y軸建立起笛卡爾三維坐標(biāo)系。通過(guò)對(duì)30例中國(guó)健康成人大腦內(nèi)囊薄層MRI圖像的研究，找到內(nèi)囊在橫斷面上的形態(tài)特征規(guī)律；建立關(guān)于內(nèi)囊的外側(cè)邊緣及內(nèi)側(cè)邊緣立體定位數(shù)據(jù)集，分析其在坐標(biāo)系中的投影圖及回歸方程；分析內(nèi)囊的非對(duì)稱性；重建內(nèi)囊在大腦中的可視化模型。為功能神經(jīng)外科立體定向、放射外科立體定向及微創(chuàng)神經(jīng)外科和研究?jī)?nèi)囊的發(fā)育及其結(jié)構(gòu)與功能的關(guān)系提供解剖學(xué)基礎(chǔ)。 第一部分：基于前后連合間徑定位體系的大腦內(nèi)囊斷層影像解剖學(xué) 目的：通過(guò)研究以基于AC-PC間線為掃描基線的活體薄層MRI圖像，總結(jié)大腦內(nèi)囊在水平切面上的形態(tài)學(xué)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(jì)算機(jī)上將掃描得到的數(shù)據(jù)以Dicom3.0的格式導(dǎo)入eFilm2.1工作站。使用“3D-Cursor”技術(shù)來(lái)識(shí)別大腦內(nèi)囊區(qū)域，觀測(cè)、統(tǒng)計(jì)其形態(tài)特征。 結(jié)果：識(shí)別出在三維薄層MRI圖像連續(xù)層面上的內(nèi)囊，并且總結(jié)出內(nèi)囊的形態(tài)及位置變化規(guī)律。 結(jié)論：使用“3D-Cursor”技術(shù)對(duì)照容易識(shí)別的冠狀面，能夠準(zhǔn)確識(shí)別在橫斷面薄層MRI圖像連續(xù)層面上的內(nèi)囊，為基底節(jié)區(qū)的病灶定位提供解剖學(xué)基礎(chǔ)。內(nèi)囊連續(xù)層面的識(shí)別分析為臨床影像診斷學(xué)和大腦的發(fā)生發(fā)育學(xué)提供參考依據(jù)。 第二部分：內(nèi)囊內(nèi)側(cè)緣及外側(cè)緣立體定位數(shù)據(jù)集的構(gòu)建及投影回歸分析 目的：構(gòu)建內(nèi)囊內(nèi)側(cè)邊緣及外側(cè)邊緣在基于連合間徑定位體系中的立體定位數(shù)據(jù)集；得出內(nèi)囊在橫、矢狀面和冠狀面的投影圖；求出內(nèi)囊內(nèi)外側(cè)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(shù)據(jù)以JPG格式導(dǎo)出并保存，然后再導(dǎo)入Photoshop軟件，圖像經(jīng)過(guò)嚴(yán)格配準(zhǔn)，使基于連合間徑的笛卡爾三維坐標(biāo)系的原點(diǎn)、X軸、Y軸與軟件自身的坐標(biāo)體系重合。分別測(cè)量并且記錄內(nèi)囊內(nèi)側(cè)邊緣及外側(cè)邊緣的坐標(biāo)值X、Y值，Z值即為所在層面距離AC-PC平面的層數(shù)與層厚的乘積，，所有采樣點(diǎn)的坐標(biāo)值構(gòu)成內(nèi)囊在三維坐標(biāo)系中的立體定位數(shù)據(jù)集；使用30名志愿者已經(jīng)獲得的數(shù)據(jù)，在SPSS軟件內(nèi)完成橫、矢狀面和冠狀面的投影圖；采用SPSS17.0軟件得出內(nèi)囊在各投影方向的回歸方程。結(jié)果：構(gòu)建出正常成年男性及女性內(nèi)囊內(nèi)外側(cè)邊緣在三維坐標(biāo)系中的立體定位數(shù)據(jù)集；統(tǒng)計(jì)繪制了橫、矢狀面和冠狀面的投影圖；得出了內(nèi)囊內(nèi)外側(cè)邊緣在各投影平面上的回歸方程。 結(jié)論：內(nèi)囊在基于連合間徑定位體系中的立體定位數(shù)據(jù)集的構(gòu)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(duì)于應(yīng)用立體定向技術(shù)及功能神經(jīng)外科學(xué)提供解剖學(xué)基礎(chǔ)；對(duì)于揭示大腦深部區(qū)域的發(fā)生、發(fā)育等形態(tài)學(xué)規(guī)律同樣具有重要的意義。 第三部分：內(nèi)囊的非對(duì)稱性研究 目的：觀測(cè)、分析內(nèi)囊是否存在性別和側(cè)別的非對(duì)稱性。 方法：在微型計(jì)算機(jī)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(nèi)囊出現(xiàn)的層面，將圖像導(dǎo)入Photoshop軟件中來(lái)測(cè)量，進(jìn)而得出內(nèi)囊區(qū)男、女性左右兩側(cè)距正中矢狀面的距離，經(jīng)SPSS17.0軟件統(tǒng)計(jì)得出男、女性左右兩側(cè)距離差異。 結(jié)果：統(tǒng)計(jì)了男、女性兩側(cè)內(nèi)囊在水平面上的映射側(cè)別差異及性別差異。 結(jié)論：男、女性左右兩側(cè)內(nèi)囊在水平面上的映射關(guān)系，是否可以表述為相同性別國(guó)人群體兩側(cè)內(nèi)囊以正中矢狀面呈“鏡像對(duì)稱”，不同性別國(guó)人群體兩側(cè)內(nèi)囊男性較女性大。 第四部分：大腦內(nèi)囊的三維重建與可視化 目的：為內(nèi)囊及鄰近周邊區(qū)域結(jié)構(gòu)的立體定位、放射立體定向、微創(chuàng)神經(jīng)外科立體定向以及解剖學(xué)教學(xué)等提供三維可視化模型。 方法：在微型計(jì)算機(jī)上，正常成人5名（沒(méi)有神經(jīng)、精神病史及家族史）大腦橫斷層2mm薄層MRI圖像掃描數(shù)據(jù)以Dicom3.0的格式導(dǎo)入3D-Doctor軟件，手動(dòng)分割內(nèi)囊、基底核區(qū)、側(cè)腦室、腦的表面等感興趣區(qū)，分別用不同的色彩標(biāo)記，以復(fù)雜表面重建方法三維重建上述各個(gè)結(jié)構(gòu)。 結(jié)果：成功重建了內(nèi)囊、基底核區(qū)及側(cè)腦室在大腦中的三維可視化模型，可以任意方位對(duì)模型進(jìn)行旋轉(zhuǎn)，從各個(gè)角度再現(xiàn)了內(nèi)囊、基底核區(qū)及側(cè)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(guān)系。 結(jié)論：內(nèi)囊的三維可視化模型展現(xiàn)了內(nèi)囊在活體腦中的三維空間結(jié)構(gòu)及毗鄰關(guān)系，為腦內(nèi)占位性病變的重建和觀測(cè)，提供了重要的方法。對(duì)立體定向神經(jīng)外科手術(shù)入路的制定、介入放射科放療計(jì)劃的實(shí)施以及醫(yī)學(xué)教學(xué)具有重要的價(jià)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(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R445.2

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