RTOG海马勾画共识中文版

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,泉州市第一医院放疗科内学习材料,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,海马勾画:,RTOG 0933,勾画图谱,Vinai Gondi, M.D.,1,Wolfgang A. Tome, Ph.D.,1,Howard A. Rowley, M.D.,2,Minesh,P.,Mehta, M.D.,3,Departments of,1,Human Oncology and,2,Neuroradiology, University of Wisconsin Comprehensive Cancer Center,3,Department of Radiation Oncology, Northwestern University,Feinberg,School of Medicine,1,MRI-CT,融合,MRI:,三维扰相梯度,(3D-SPGR),轴位,MRI,以标准轴位和冠状位,FLAIR,扫描头部,获取轴位,T2,加权和钆对比增强的,T1,加权序列。,推荐采用1.25,mm,层厚,以准确勾画海马,。,小于或等于1.5,mm,层厚也可以,。,仰卧位；不需要用,CT,模拟和日常治疗的固定装置,。,CT,模拟:,对全头颅行不增强的治疗计划,CT。,推荐采用1.25-1.5,mm,层厚准确勾画海马,。,小于或等于2.5,mm,层厚也可以,。,用面罩等装置将患者固定于仰卧位。治疗病人时也应该使用固定装置,。,MRI-CT Fusion:,将,3D-SPGR MRI,和治疗计划,CT,融合,。,2,一般原理,请注意我们并不是勾画整个海马,而更关注的是齿状回颗粒细胞亚区,(SGZ),在,MRI,的,T1,加权轴位序列上勾画海马,。,由于海马中灰质占优势，主要在勾画颞角内侧的,T1,低信号区。,3,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),红色,:,海马,从侧脑室颞角的新月形底部作为尾侧（下）勾画的起始部位，在脑脊液低信号内侧勾画低密度的灰质，而不画又白又亮的白质,。,4,颞角,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),Fimbriae,5,继续向头侧方向（上）勾画，在侧脑室颞角的内侧勾画低密度的灰质，而不是又白又亮的白质。,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),6,继续向头侧方向（上）勾画，,避免勾画伞部，这是一个位于海马上内侧的,T1,高密度结构。,伞部,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),7,继续向头侧方向（上）勾画，在侧脑室颞角的内侧勾画低密度的灰质，而不是又白又亮的白质。注意勾画是向上后方逐渐移动，保持海马的香蕉形结构曲线,。,避过伞部和位于侧脑室颞角尖部前方的灰质（杏仁核和钩）,。,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),8,在向后方、头侧勾画的过程中，以颞角的前缘作为海马的前界,，,以区分在,T1,相上同为低密度灰质的杏仁核和钩,，,这两个结构位于 海马的前上方。,海马的内侧界是,“boomerang（,飞镖）形,”,的钩,。,杏仁核,钩,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),9,Uncal,Recess,Uncal,Recess,继续向头侧方向（上）勾画，在侧脑室颞角的内侧勾画低密度的灰质，而不是又白又亮的白质。避免勾画伞部和位于侧脑室颞角尖部前方的灰质（杏仁核和钩）,。,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),颞角杏仁核窝的出现界定了海马的前缘,。,但它的体积有限，不能在所有轴位影像上出现,。,海马 的内侧界是杏仁核窝的内侧缘,。,10,Medial edge of,Uncal,Recess,钩隐窝,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),11,继续向头侧方向（上）勾画，在侧脑室颞角的内侧勾画低密度的灰质，而不是又白又亮的白质。避免勾画伞部和位于侧脑室颞角尖部前方的灰质（杏仁核和钩）,。,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),向后向头侧，海马的内侧界定义为四叠体池的外侧缘， 四叠体池,是脑干外侧,的脑脊液间隙,。,12,四叠体池,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),13,继续向头侧（上方）勾画，应注意在这个水平，侧脑室的颞角（,temporal horn,）不再是每个层面都能看到， 但四叠体池,cistern,作为内侧标志。只勾画低密度的灰质，而不是亮的白质。,四叠体池,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),海马在侧脑室颞角存在时一直位于其内侧，在可以见到侧脑室的层面，把它作为一个 稳定的标志四叠体池 仍然是一个好的内侧标志。,14,侧脑室颞角,四叠体池,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),15,四叠体池,海马在侧脑室颞角存在时一直位于其内侧，在可以见到侧脑室的层面，把它作为一个 稳定的标志四叠体池 仍然是一个好的内侧标志。,侧脑室颞角,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),16,海马尾部仍然位于丘脑后方，它内侧弯向胼胝体。注意它的内侧仍然是侧脑室。同时也要注意丘脑、基底节和内囊在这个层面上也出现了。,丘脑,四叠体池,尾状核,豆状核,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),17,内囊,海马尾部仍然位于丘脑后方，它内侧弯向胼胝体。注意它的内侧仍然是侧脑室。同时也要注意丘脑、基底节和内囊在这个层面上也出现了。,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),18,海马尾部向后向头侧延续正好位于侧脑室腔的前内侧。,侧脑室腔,海马尾部,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),19,海马尾部向后向头侧延续正好位于侧脑室腔的前内侧。,侧脑室腔,海马尾,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),甚至在头侧（上）方向，海马尾仍然四叠体池外侧缘的外侧.,20,四叠体池,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),21,甚至在头侧（上）方向，海马尾仍然四叠体池外侧缘的外侧.,四叠体池,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),当,T1,低,信号的结构不再靠近侧脑室边缘时海马的勾画结束。,在,这个位置的前方穹窿的十字出现，其后方可见胼胝体的压部,。,22,压部,红色: 海马,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted,Tomography,22,324-333 (1998),23,海马的灰色信号消失，再也不用画了,。,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted,Tomography,22,324-333 (1998),海马外扩5,mm，,生成海马回避区.,24,红色: 海马,绿色:海马保护区,红色: 海马,绿色:海马保护区,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted,Tomography,22,324-333 (1998),25,Hippocampal,1) Tail,2) Body,3) Head,海马外扩5,mm，,生成海马回避区.,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),26,Hippocampal,1) Tail,2) Body,3) Head,红色: 海马,绿色:海马保护区,海马,1),尾,2),体,3),头,海马分成三个解剖亚区：头、体、尾,；,注意头部位于下方或尾侧，体部位于上后方而尾部是最头侧的（上）而且是最后方的，在矢状位上侧脑室平面上总体呈“香蕉”形。,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted,Tomography,22,324-333 (1998),27,Hippocampal,1) Tail,2) Body,3) Head,红色: 海马,绿色:海马保护区,海马分成三个解剖亚区：头、体、尾,；,注意头部位于下方或尾侧，体部位于上后方而尾部是最头侧的（上）而且是最后方的，在矢状位上侧脑室平面上总体呈“香蕉”形。,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),在矢状位上确认海马与邻近结构相分离，如杏仁核。,28,Hippocampal,1) Tail,2) Body,3) Head,红色: 海马,绿色:海马保护区,杏仁核,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),29,Hippocampal,1) Tail,2) Body,3) Head,红色: 海马,绿色:海马保护区,在矢状位上确认海马与邻近结构相分离，如杏仁核。,杏仁核,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),30,Hippocampal,1) Tail,2) Body,3) Head,红色: 海马,绿色:海马保护区,在冠状位上确认海马与邻近结构相分离，如海马旁回，它们有不同的信号强度。,海马旁回,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),31,Hippocampal,1) Tail,2) Body,3) Head,红色: 海马,绿色:海马保护区,在冠状位上确认海马与邻近结构相分离，如海马旁回，它们有不同的信号强度。,海马旁回,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),在矢状位和冠状位上确认海马尾部与穹窿脚分离，如海马旁回，它们有不同的信号强度。,注意冠状位上海马位于侧脑室内侧。,32,Hippocampal,1) Tail,2) Body,3) Head,红色: 海马,绿色:海马保护区,穹隆脚,穹隆脚,MR Images courtesy of: Holmes CJ,Hoge,R, Collins L, et al. Enhancement of MR Images Using Registration for Signal Averaging Journal of Computer Assisted Tomography 22,324-333 (1998),33,Hippocampal,1) Tail,2) Body,3) Head,红色: 海马,绿色:海马保护区,在矢状位和冠状位上确认海马尾部与穹窿脚分离，如海马旁回，它们有不同的信号强度。,注意冠状位上海马位于侧脑室内侧。,