虽然代谢成像，如氟18氟脱氧葡萄糖（FDG）PET在恶性肿瘤的诊断和分期产生了重大的影响，其在肿瘤介入方面的作用是有限的，缺乏足够的解剖细节来指导介入手术。但PET/CT，甚至PET/MRI的存在，介入手术通常应用也只用MRI或CT部分，而不是PET。为了更好地应用PET引导介入治疗的手术，必须是PET与介入CT的图像融合或重叠，充分利用CT或MRI提供的解剖细节和PET的生理信息。【76 - 79】。 超声图像也可以与CT图像融合，以获取介入手术之前所得到的没有电离辐射的增强超声和诊断增强CT的解剖细节【80,81】。另外，MR图像可以与术中没有增强的CT影像融合更好的描述肿瘤边缘【82】。融合也被用来重叠透视旋转血管造影、CT或MR图像为栓塞手术时提供更多的引导【83】（图5）。
多模式的图像融合技术虽然可以大大地帮助肿瘤介入放射医生的介入治疗，但这种图像融合工程仍然充满挑战【84】。患者的呼吸，病人的定位，甚至手术操作和/或器械相关的运动，以及产生的伪影都是目前技术工程方面的障碍【85】。杂交，CT、血管造影或MRI、血管造影设备组合机房设计，患者在同一张手术床上，同一位置，如何让两种影像更容易和快速的进行影像配准（image registration）还有很多问题需要解决。花费效益和软件融合技术可能在未来进一步改善一次操作手术多影像方式集合的获益
76. Yap JT, Carney JP, Hall NC, Townsend DW. Image-guided cancer therapy using PET/CT. Cancer J 2004;10(4):221–233.
77. Veit P, Kuehle C, Beyer T, Kuehl H, Bockisch A, Antoch G. Accuracy of combined PET/CT in image-guided interventions of liver lesions: an ex-vivo study. World J Gastroenterol 2006;12(15):2388–2393.
78. Heron DE, Smith RP, Andrade RS. Advances in image-guided radiation therapy: the role of PET-CT. Med Dosim 2006;31(1):3–11.
79. Giesel FL, Mehndiratta A, Locklin J, et al.. Image fusion using CT, MRI and PET for treatment planning, navigation and follow up in percutaneous RFA. Exp Oncol 2009;31(2):106–114.
80. Crocetti L, Lencioni R, Debeni S, See TC, Pina CD, Bartolozzi C. Targeting liver lesions for radiofrequency ablation: an experimental feasibility study using a CT-US fusion imaging system. Invest Radiol 2008;43(1):33–39.
81. Wein W, Röper B, Navab N. Automatic registration and fusion of ultrasound with CT for radiotherapy. Med Image Comput Comput Assist Interv 2005;8(pt 2):303–311.
82. Archip N, Tatli S, Morrison P, Jolesz F, Warfield SK, Silverman SG. Non-rigid registration of pre-procedural MR images with intra-procedural unenhanced CT images for improved targeting of tumors during liver radiofrequency ablations. Med Image Comput Comput Assist Interv 2007;10(pt 2):969–977.
83. Gutiérrez LF, Silva R, Ozturk C, et al.. Technology preview: x-ray fused with magnetic resonance during invasive cardiovascular procedures. Catheter Cardiovasc Interv 2007;70(6):773–782.
84. Solomon SB. Incorporating CT, MR imaging, and positron emission tomography into minimally invasive therapies. J Vasc Interv Radiol 2005;16(4):445–447.
85. Cleary K, Zhang H, Glossop N, Levy E, Wood B, Banovac F. Electromagnetic tracking for image-guided abdominal procedures: overall system and technical issues. Conf Proc IEEE Eng Med Biol Soc 2005;7:6748–6753.
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