低劑量術中電腦斷層導航系統暨磁振造影融合執行經皮三叉神經射頻燒灼術

經皮三叉神經射頻燒灼術（percutaneous radiofrequency trigeminal rhizotomy, RF-TR）是治療典型三叉神經痛（trigeminal neuralgia）的手術方式，手術過程使用術中電腦斷層（intra-operative computed tomography,iCT）導航系統融合磁振造影（magnetic resonance imaging, MRI）影像製作治療計畫與輔助導引細針穿刺。眼球水晶體是人體中對輻射最敏感的組織之一，近來研究指出輻射造成水晶體傷害的低限值應該更小，甚至是無低限值，因此合理抑低術中電腦斷層導航系統之水晶體輻射曝露是相當重要。此研究回溯收集20例使用標準劑量（100 kV/200 mAs）和20 例使用低劑量（100 kV/80 mAs）掃描參數執行RF-TR 治療之病例資料，以細針針尖至三叉神經節的距離作為影像評估，並比較其掃描次數、水晶體輻射劑量和有效劑量。分析結果顯示低劑量組和標準劑量組之針尖至神經節的距離分別2.6±1.4 mm 和2.3±1.1 mm（p＞0.05），掃描次數分別為2.6±1.1 次和2.6±0.9 次（p＞0.05），兩者無明顯差異。低劑量組和標準劑量組之水晶體劑量分別為16.7±5.1 mGy 和46.8±12.7 mGy（p＜0.001），有效劑量分別為0.7±0.1 mSv 和1.7±0.2 mSv（p＜0.001），兩者皆有非常明顯差異。因此低劑量術中電腦斷層掃描暨磁振造影融合執行經皮三叉神經射頻燒灼術可以有效減少眼球水晶體曝露約64%和有效劑量約59%，防止確定效應之發生和抑低機率效應之發生率，且影像品質不影響細針之導引穿刺。

關鍵字

經皮三叉神經射頻燒灼術；低劑量電腦斷層；三叉神經痛；術中電腦斷層

並列摘要

Percutaneous radiofrequency trigeminal rhizotomy (RF-TR) has been considered to be an effective treatment modality for trigeminal neuraligia. The procedure is guided by intra-operative computed tomography neuronavigation with MRI fusion at our institute. The lens is relatively radiosensitive, and cataract formation has been documented as a major ocular complication associated with exposure to ionizing radiation. It is an issue to limit and reduce radiation dose to the eye, especially in patients who require repeated scanning during RF-TR. To compare the image quality and radiation dose of the low-dose (100 kV/80 mAs) to the standard-dose (100 kV/200 mAs) protocol, we retrospectively collected the image data of 40 patients (20 patients using low-dose protocol and 20 patients using the standard-dose protocol), including the needle to trigeminal ganglion distance, the lens dose, the effective dose and the scan times. Of the 40 patients selected for analysis, the average distance for low-dose and the standard-dose protocols were 2.6±1.4 mm and 2.3±1.1 mm (p＞0.05). The average scan times were 2.6±1.1 and 2.6±0.9 (p＞0.05). The result showed no significant difference in the scan times and the needle to trigeminal ganglion distance. The average lens dose for the low-dose and standard-dose protocols were 16.7±5.1 mGy and4 6.8±12.7 mGy (p＜0.001). The average effective dose for the low-dose and standard-dose protocols were 0.7±0.1 mSv and 1.7±0.2 mSv (p＜0.001). Using low-dose CT resulted in a significant reduction of the radiation doses to the lens and brain by 64% and 59%, respectively, without causing any significant effect to the RF-TR procedure and assessment of the anatomical bone structures.

並列關鍵字

percutaneous radiofrequency trigeminal rhizotomy ； trigeminal neuralgia ； intra-operative low-dose computed tomography

國際替代計量

低劑量術中電腦斷層導航系統暨磁振造影融合執行經皮三叉神經射頻燒灼術

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