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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (1): 53-58. doi: 10.19723/j.issn.1671-167X.2019.01.010

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Multimodal image fusion technology for diagnosis and treatment of the skull base-infratemporal tumors

Rong YANG,Qing-xiang LI,Chi MAO,Xin PENG,Yang WANG,Yu-xing GUO(),Chuan-bin GUO()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2018-10-09 Online:2019-02-18 Published:2019-02-26
  • Contact: Yu-xing GUO,Chuan-bin GUO E-mail:gladiater1984@163.com;guodazuo@sina.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81672664);and the Capital Featured Clinical Application Research Project of Beijing Municipal Science & Technology Commission(Z161100000516043)

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Abstract:

Objective: To explore the value of incorporated multimodal image fusion technology with computer-aided design of the skull base-infratemporal tumor treatment. Methods: A retrospective study was carried out to enroll seventeen patients with skull base-infratemporal tumors treated at Peking University Hospital of Stomatology from February 2011 to September 2018. Plain CT, enhanced CT and MRI data were imported into the iPlan 3.0 software (BrainLab navigation system), and the image fusion was performed for each patient preoperatively. Then the three-dimensional images of the tumor, vital vessels and craniofacial bones were reconstructed to prepare virtual operation design. We evaluated the application of multimodal image fusion technology that had been incorporated with computer-aided planning during the navigation-guided biopsy or surgery, through the analysis of the biopsy and operation data and re-gular follow-up postoperatively. Results: The mean age of 17 patients (7 males and 10 females) was 46 years. Primary tumors occurred in 11 cases, and recurrent tumors in 6 cases. The size of the 17 tumors ranged from 2.9 cm to 9 cm, and the mean size was 4.35 cm. There were 7 cases with skull base bone destruction and/or intracranial extension, and 10 cases with tumors adjacent to the skull base. High-quality multimodal fused images were obtained in all the 17 cases. The spatial-position relationships of the tumors, adjacent craniomaxillofacial bones and vital vessels labeled with different colors were displayed well on the generated fusion images. The multimodal image fusion technology that incorporated with computer-aided three-dimensional reconstruction and then applied in navigation-guided biopsy or surgery showed that, preoperative analysis and virtual operation design functioned with good results, especially in cases with small tumor size, recurrence or ill-defined borders in the skull base-infratemporal region. Operation was carried out in 16 cases after preoperative diagnosis and assessment, and 1 case was performed by navigation-guided biopsy only. The proportions of navigation-guided surgery and biopsy were 70.6% (12/17) and 17.6% (3/17) individually. The positive rate of pathologic diagnosis using navigation-guided biopsy was 100% (3/3). All the navigation-guided biopsies or operations were carried out successfully. Complications included 1 case of cerebrospinal fluid leak from a recurred meningioma patient postoperatively, and 1 case of facial paralysis resulting from parotid-gland deep lobe tumor. Most (14/15) tumors got complete removal with safe boundary through intra-operative navigation verification and post-operative imaging confirmation, except for one case of subtotal resection to avoid the injury of cavernous sinus. The pathological results of the tumors could be classified to mesenchymal (10), adenogenous (3), neurogenic (3) or epithelial (1) resources. The follow-up time ranged from 3 to 94 months, with the median follow-up time of 9 months. Conclusion:Taking full advantages of individualized multimodal images, could help analyze the three-dimensional spatial position relationship of tumors, vital vessels and craniofacial bones properly, and then complete the virtual operation design well. The incorporated multimodal image fusion technology with navigation technology may improve the accuracy and safety of core needle biopsy and surgical treatment of skull base-infratemporal tumors.

Key words: Skull base-infratemporal region, Tumor, Multimodal, Image fusion, Surgical treatment

CLC Number: 

  • R78

Figure 1

Protocol of multimodal image fusion incorporated with computer-aided design to remove the skull base-infratemporal tumors"

Figure 2

Protocol of multimodal image fusion technique used during the navigation-guided biopsy or surgery of skull base-infratemporal tumor A, plain CT image of the patient to display bony structures; B, enhanced CT image to show the vital vessels such as internal carotid artery (ICA, red arrow) and internal jugular vein (IJV, blue arrow); C, MR image to indicate the tumor margin clearly (green dotted line); D, the data of plain CT, enhanced CT and MRI data was imported into the design software of navigation system (iPlan 3.0, BrainLab) and image fusion was performed. The precision of image fusion was verified by the coincidence of eyeballs and skull bone from MR and CT images, indicating by the smooth and continuous evolution trend of image edges from CT (outside of red box) to MR images (inside of red box); E, bony structures (yellow) generated by plain CT, ICA (red) and IJV (blue) by enhanced CT, and tumor by MR image were shown in the multimodal fused image; F, the reconstructed craniomaxillofacial bone, vital vessels (ICA and IJV), tumor and the navigation-guided biopsy route (purple color line) were shown in three-dimensional image that will be used in biopsy operation."

Table 1

General data of the patients"

Items Data
Male/female 7/10
Age/years 46
Chief complaint
Swelling 9
Dysfunction 10
Paresthesia 11
Type of tumor
Primary 11
Recurrent 6
Tumor size/cm 4.35
Relationship with skull base bone*
Defected 7
Adjacent 10
Primary site of lesion
Temporomandibular joint 7
Infratemporal fossa 6
Deep lobe of parotid gland 3
Meninges 1
Surgery approach#
Lateral approach 9
Inferior approach 5
Anterior approach 1
Pathological type&
Mesenchymal 10
Adenogenous 3
Neurogenic 3
Epithelial 1

Figure 3

Typical case report. A 45-year-old male patient complained with hearing weakened for 2 months,and found a mass at the right infratemporal fossa A, plain CT image showed an ill-defined soft tissue mass at the right infratemporal fossa with the skull base defected (purple arrow); B, T2-weighted MR image demonstrated a high signal and well-defined mass (green dotted line); C, the precision verification of multimodal image fusion (enhanced CT and MRI); D, three dimensional image of the tumor, craniomaxillofacial bone, internal carotid artery and internal jugular vein generated from multimodal image fusion technique; E and F, using the navigation probes to confirm the extent of the tumor resection intra-operatively."

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