Neurological Surgery 脳神経外科35巻4号

2007年04月発行

総説

画像誘導治療

著者： 松前光紀¹ 厚見秀樹¹

所属機関： ¹東海大学医学部外科学系脳神経外科領域

ページ範囲：P.329 - P.342

Ⅰ．はじめに

　1993年BostonのBrigham and Women's Hospitalに初めての術中magnetic resonance imaging（MRI）装置が導入されて以来，脳神経外科領域における画像誘導治療は飛躍的に進歩した．われわれ脳神経外科医は，stereotaxic frame，術中computed tomography（CT），術中angiography,ナビゲーションシステムなど，数々の先駆的技術を手術の現場に導入してきた．しかし術中MRIの導入は，単にbrain shiftに対応する頻回のimage updateや，術中の詳細な解剖学的情報をわれわれに提供するのみではない．いくつかのシーケンスを組み合わせることによるtissue characterization，水分子プロトンの異方性を利用したdiffusion tensor imaging（DTI），磁化率の変化を脳機能と合わせ可視化したfunctional MRI（fMRI），代謝産物を観察するmagnetic resonance spectroscopy（MRS）など，従来の診断機器では不可能であった生体情報を得ることを可能とした．特に脳内の物理的変量である，温度・圧力・流体の流れなどのMRIによる計測は，近年新しい非侵襲的治療の概念を打ち出しており，今後の方向性として重要である．

　本稿では，最初に術中画像診断の変遷を述べ，次に最近登場した新しいタイプの手術室を紹介する．そして最後に，MRIを用いた脳内物理的変量の計測，MRI温度計測法を利用した低侵襲治療，新しい画像合成技術，MRI撮像下血管内カテーテル誘導など，他領域で研究されている技術についても紹介し，画像誘導治療の将来について言及する．

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