scholarly journals Comparison of intraoperative MR imaging and 3D-navigated ultrasonography in the detection and resection control of lesions

2001 ◽  
Vol 10 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Volker M. Tronnier ◽  
Matteo M. Bonsanto ◽  
Andreas Staubert ◽  
Michael Knauth ◽  
Stefan Kunze ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Lesion Detection ◽  
Imaging Modalities ◽  
Attractive Alternative ◽  
Low Grade ◽  
Resection Control ◽  
Low Field ◽  
Supratentorial Gliomas

Object The authors undertook a study to compare two intraoperative imaging modalities, low-field magnetic resonance (MR) imaging and a prototype of a three-dimensional (3D)–navigated ultrasonography in terms of imaging quality in lesion detection and intraoperative resection control. Methods Low-field MR imaging was used for intraoperative resection control and update of navigational data in 101 patients with supratentorial gliomas. Thirty-five patients with different lesions underwent surgery in which the prototype of a 3D-navigated ultrasonography system was used. A prospective comparative study of both intraoperative imaging modalities was initiated with the first seven cases presented here. In 35 patients (70%) in whom ultrasonography was performed, accurate tumor delineation was demonstrated prior to tumor resection. In the remaining 30% comparison of preoperative MR imaging data and ultrasonography data allowed sufficient anatomical localization to be achieved. Detection of metastases and high-grade gliomas and intra-operative delineation of tumor remnants were comparable between both imaging modalities. In one case of a low-grade glioma better visibility was achieved with ultrasonography. However, intraoperative findings after resection were still difficult to interpret with ultrasonography alone most likely due to the beginning of a learning curve. Conclusions Based on these preliminary results, intraoperative MR imaging remains superior to intraoperative ultrasonography in terms of resection control in glioma surgery. Nevertheless, the different features (different planes of slices, any-plane slicing, and creation of a 3D volume and matching of images) of this new ultrasonography system make this tool a very attractive alternative. The intended study of both imaging modalities will hopefully allow a comparison regarding sensitivity and specificity of intraoperative tumor remnant detection, as well as cost effectiveness.

Intraoperative magnetic resonance imaging during transsphenoidal surgery

2001 ◽  
Vol 95 (3) ◽  
pp. 381-390 ◽  
Author(s):  
Rudolf Fahlbusch ◽  
Oliver Ganslandt ◽  
Michael Buchfelder ◽  
Werner Schott ◽  
Christopher Nimsky
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Early Stage ◽  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Tumor Removal ◽  
Content Type ◽  
Early Evaluation ◽  
Flexible Coil ◽  
Fine Print

Object. The aim of this study was to evaluate whether intraoperative magnetic resonance (MR) imaging can increase the efficacy of transsphenoidal microsurgery, primarily in non—hormone-secreting intra- and suprasellar pituitary macroadenomas. Methods. Intraoperative imaging was performed using a 0.2-tesla MR imager, which was located in a specially designed operating room. The patient was placed supine on the sliding table of the MR imager, with the head placed near the 5-gauss line. A standard flexible coil was placed around the patient's forehead. Microsurgery was performed using MR-compatible instruments. Image acquisition was started after the sliding table had been moved into the center of the magnet. Coronal and sagittal T1-weighted images each required over 8 minutes to acquire, and T2-weighted images were obtained optionally. To assess the reliability of intraoperative evaluation of tumor resection, the intraoperative findings were compared with those on conventional postoperative 1.5-tesla MR images, which were obtained 2 to 3 months after surgery. Among 44 patients with large intra- and suprasellar pituitary adenomas that were mainly hormonally inactive, intraoperative MR imaging allowed an ultra-early evaluation of tumor resection in 73% of cases; such an evaluation is normally only possible 2 to 3 months after surgery. A second intraoperative examination of 24 patients for suspected tumor remnants led to additional resection in 15 patients (34%). Conclusions. Intraoperative MR imaging undoubtedly offers the option of a second look within the same surgical procedure, if incomplete tumor resection is suspected. Thus, the rate of procedures during which complete tumor removal is achieved can be improved. Furthermore, additional treatments for those patients in whom tumor removal was incomplete can be planned at an early stage, namely just after surgery.

Intracranial navigation by using low-field intraoperative magnetic resonance imaging: preliminary experience

2002 ◽  
Vol 97 (5) ◽  
pp. 1115-1124 ◽  
Author(s):  
Andrew A. Kanner ◽  
Michael A. Vogelbaum ◽  
Marc R. Mayberg ◽  
Joseph P. Weisenberger ◽  
Gene H. Barnett
Keyword(s):  
Magnetic Resonance ◽  
Imaging System ◽  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Cortical Mapping ◽  
Subtotal Resection ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Low Field ◽  
Fine Print

Object. Intracranial navigation by using intraoperative magnetic resonance (iMR) imaging allows the surgeon to reassess anatomical relationships in near—real time during brain tumor surgery. The authors report their initial experience with a novel neuronavigation system coupled to a low-field iMR imaging system. Methods. Between October 2000 and December 2001, 70 neurosurgical procedures were performed using the mobile 0.12-tesla PoleStar N-10 iMR imaging system. The cases included 38 craniotomies, 15 brain biopsies, nine transsphenoidal approaches, and one drainage of a subdural hematoma. Tumor resection was performed using the awake method in seven of 38 cases. Of the craniotomies, image-confirmed complete or radical tumor resection was achieved in 28 cases, subtotal resection in eight cases, and open biopsies in two cases. Tumor resection was controlled with the use of image guidance until the final intraoperative images demonstrated that there was no residual tumor or that no critical brain tissue was at risk of compromise. In each stereotactic biopsy the location of the biopsy needle could be verified by intraoperative imaging and diagnostic tissue was obtained. Complications included a case of aseptic meningitis after a biopsy and one case of temporary intraoperative failure of the anesthesia machine. Awake craniotomies were performed successfully with no permanent neurological complications. Conclusions. Intraoperative MR image—based neuronavigation is feasible when using the Odin PoleStar N-10 system for tumor resections that require multiple other surgical adjuncts including awake procedures, cortical mapping, monitoring of somatosensory evoked potentials, or electrocorticography. Use of the system for brain biopsies offers the opportunity of immediate verification of the needle tip location. Standard neurosurgical drills, microscopes, and other equipment can be used safely in conjunction with this iMR imaging system.

Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas

Neurosurgery ◽  
2016 ◽  
Vol 79 (4) ◽  
pp. 604-612 ◽  
Author(s):  
Vladislav Pavlov ◽  
David Meyronet ◽  
Vincent Meyer-Bisch ◽  
Xavier Armoiry ◽  
Brian Pikul ◽  
...  
Keyword(s):  
Open Surgery ◽  
Stereotactic Biopsy ◽  
Aminolevulinic Acid ◽  
Intraoperative Imaging ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Low Grade ◽  
Histologic Diagnosis

Abstract BACKGROUND: The management of gliomas is based on precise histologic diagnosis. The tumor tissue can be obtained during open surgery or via stereotactic biopsy. Intraoperative tissue imaging could substantially improve biopsy precision and, ultimately, the extent of resection. OBJECTIVE: To show the feasibility of intraoperative in vivo probe-based confocal laser endomicroscopy (pCLE) in surgery and biopsy of gliomas. METHODS: In our prospective observational study, 9 adult patients were enrolled between September 2014 and January 2015. Two contrast agents were used: 5-aminolevulinic acid (3 cases) or intravenous fluorescein (6 cases). Intraoperative imaging was performed with the Cellvizio system (Mauna Kea Technologies, Paris). A 0.85-mm probe was used for stereotactic procedures, with the biopsy needle modified to have a distal opening. During open brain surgery, a 2.36-mm probe was used. Each series corresponds to a separate histologic fragment. RESULTS: The diagnoses of the lesions were glioblastoma (4 cases), low-grade glioma (2), grade III oligoastrocytoma (2), and lymphoma (1). Autofluorescence of neurons in cortex was observed. Cellvizio images enabled differentiation of healthy “normal” tissue from pathological tissue in open surgery and stereotactic biopsy using fluorescein. 5-Aminolevulinic acid confocal patterns were difficult to establish. No intraoperative complications related to pCLE or to use of either contrast agent were observed. CONCLUSION: We report the initial feasibility and safety of intraoperative pCLE during primary brain tumor resection and stereotactic biopsy procedures. Pending further investigation, pCLE of brain tissue could be utilized for intraoperative surgical guidance, improvement in brain biopsy yield, and optimization of glioma resection via analysis of tumor margins.

scholarly journals Intraoperative Imaging Modalities and Compensation for Brain Shift in Tumor Resection Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-18 ◽  
Author(s):  
Siming Bayer ◽  
Andreas Maier ◽  
Martin Ostermeier ◽  
Rebecca Fahrig
Keyword(s):  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Imaging Systems ◽  
Imaging Modalities ◽  
Neurosurgical Procedures ◽  
Brain Shift ◽  
Web Tool ◽  
Modeling Methods ◽  
Image Guided ◽  
Tissue Manipulation

Intraoperative brain shift during neurosurgical procedures is a well-known phenomenon caused by gravity, tissue manipulation, tumor size, loss of cerebrospinal fluid (CSF), and use of medication. For the use of image-guided systems, this phenomenon greatly affects the accuracy of the guidance. During the last several decades, researchers have investigated how to overcome this problem. The purpose of this paper is to present a review of publications concerning different aspects of intraoperative brain shift especially in a tumor resection surgery such as intraoperative imaging systems, quantification, measurement, modeling, and registration techniques. Clinical experience of using intraoperative imaging modalities, details about registration, and modeling methods in connection with brain shift in tumor resection surgery are the focuses of this review. In total, 126 papers regarding this topic are analyzed in a comprehensive summary and are categorized according to fourteen criteria. The result of the categorization is presented in an interactive web tool. The consequences from the categorization and trends in the future are discussed at the end of this work.

Reliability of intraoperative high-resolution 2D ultrasound as an alternative to high–field strength MR imaging for tumor resection control: a prospective comparative study

2009 ◽  
Vol 111 (3) ◽  
pp. 512-519 ◽  
Author(s):  
Venelin Miloslavov Gerganov ◽  
Amir Samii ◽  
Arasch Akbarian ◽  
Lennart Stieglitz ◽  
Madjid Samii ◽  
...  
Keyword(s):  
High Resolution ◽  
Mr Imaging ◽  
Comparative Study ◽  
High Field ◽  
Blood Clot ◽  
Tumor Resection ◽  
Ultrasound Images ◽  
Resection Control ◽  
2D Ultrasound ◽  
Prospective Comparative Study

Object Ultrasound may be a reliable but simpler alternative to intraoperative MR imaging (iMR imaging) for tumor resection control. However, its reliability in the detection of tumor remnants has not been definitely proven. The aim of the study was to compare high-field iMR imaging (1.5 T) and high-resolution 2D ultrasound in terms of tumor resection control. Methods A prospective comparative study of 26 consecutive patients was performed. The following parameters were compared: the existence of tumor remnants after presumed radical removal and the quality of the images. Tumor remnants were categorized as: detectable with both imaging modalities or visible only with 1 modality. Results Tumor remnants were detected in 21 cases (80.8%) with iMR imaging. All large remnants were demonstrated with both modalities, and their image quality was good. Two-dimensional ultrasound was not as effective in detecting remnants < 1 cm. Two remnants detected with iMR imaging were missed by ultrasound. In 2 cases suspicious signals visible only on ultrasound images were misinterpreted as remnants but turned out to be a blood clot and peritumoral parenchyma. The average time for acquisition of an ultrasound image was 2 minutes, whereas that for an iMR image was ~ 10 minutes. Neither modality resulted in any procedure-related complications or morbidity. Conclusions Intraoperative MR imaging is more precise in detecting small tumor remnants than 2D ultrasound. Nevertheless, the latter may be used as a less expensive and less time-consuming alternative that provides almost real-time feedback information. Its accuracy is highest in case of more confined, deeply located remnants. In cases of more superficially located remnants, its role is more limited.

TRANSSPHENOIDAL PITUITARY MACROADENOMAS RESECTION GUIDED BY POLESTAR N20 LOW-FIELD INTRAOPERATIVE MAGNETIC RESONANCE IMAGING

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Jin-Song Wu ◽  
Xue-Fei Shou ◽  
Cheng-Jun Yao ◽  
Yong-Fei Wang ◽  
Dong-Xiao Zhuang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Transsphenoidal Surgery ◽  
High Field ◽  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Resonance Imaging ◽  
Low Field ◽  
Pituitary Macroadenomas

ABSTRACT OBJECTIVE To evaluate the applicability of low-field intraoperative magnetic resonance imaging (iMRI) during transsphenoidal surgery of pituitary macroadenomas. METHODS Fifty-five transsphenoidal surgeries were performed for macroadenomas (modified Hardy's Grade II–IV) resections. All of the surgical processes were guided by real-time updated contrast T1-weighted coronal and sagittal images, which were acquired with 0.15 Tesla PoleStar N20 iMRI (Medtronic Navigation, Louisville, CO). The definitive benefits as well as major drawbacks of low-field iMRI in transsphenoidal surgery were assessed with respect to intraoperative imaging, tumor resection control, comparison with early postoperative high-field magnetic resonance imaging, and follow-up outcomes. RESULTS Intraoperative imaging revealed residual tumor and guided extended tumor resection in 17 of 55 cases. As a result, the percentage of gross total removal of macroadenomas increased from 58.2% to 83.6%. The accuracy of imaging evaluation of low-field iMRI was 81.8%, compared with early postoperative high-field MRI (Correlation coefficient, 0.677; P &lt;0.001). A significantly lower accuracy was identified with low-field iMRI in 6 cases with cavernous sinus invasion (33.3%) in contrast to the 87.8% found with other sites (Fisher's exact test, P &lt;0.001). CONCLUSION The PoleStar N20 low-field iMRI navigation system is a promising tool for safe, minimally invasive, endonasal, transsphenoidal pituitary macroadenomas resection. It enables neurosurgeons to control the extent of tumor resection, particularly for suprasellar tumors, ensuring surgical accuracy and safety, and leading to a decreased likelihood of repeat surgeries. However, this technology is still not satisfying in estimating the amount of the parasellar residual tumor invading into cavernous sinus, given the false or uncertain images generated by low-field iMRI in this region, which are difficult to discriminate between tumor remnant and blood within the venous sinus.

Progress in long-term survival in adult patients with supratentorial low-grade gliomas: a population-based study of 993 patients in whom tumors were diagnosed between 1970 and 1993

2003 ◽  
Vol 99 (5) ◽  
pp. 854-862 ◽  
Author(s):  
Tom B. Johannesen ◽  
Frøydis Langmark ◽  
Knut Lote
Keyword(s):  
Overall Survival ◽  
Mr Imaging ◽  
Tumor Resection ◽  
Ct Scanning ◽  
Low Grade ◽  
Term Survival ◽  
Content Type ◽  
Low Grade Gliomas ◽  
Fine Print

Object. The goal of this study was to document and compare long-term survival during the periods 1970 through 1981 and 1982 through 1993 in all adult patients in Norway with histologically verified supratentorial low-grade gliomas (LGGs). Methods. Nine hundred ninety-three patients 15 to 69 years of age were found to have a primary supratentorial diffuse astrocytoma, oligodendroglioma, oligoastrocytoma, or pilocytic astrocytoma. Survival time was analyzed in all patients and, in a subset of 451 patients, the influence of new imaging methods on the time from symptom onset to imaging diagnosis was estimated. Overall median survival was 6.4 years (95% confidence interval [CI] 5.7–7.1 years). Survival times for patients in whom a diagnosis was made between 1970 and 1981 (397 patients) and between 1982 and 1993 (596 patients) were 4.1 years (95% CI 3.3–4.9 years) and 9.2 years (95% CI 7.9–10.6 years), respectively (p < 0.0001). Survival also improved in the later period within each histological subgroup. In patients in whom a biopsy was performed the median length of survival was 6.4 years (95% CI 3.1–9.7 years); in patients treated with subtotal tumor resection it was 6.8 years (95% CI 5.8–7.7 years); and in those treated with gross-total tumor resection it was 7.6 years (95% CI 5.5–9.7 years), a nonsignificant difference (p = 0.59). A considerable age-dependent variation in overall survival was demonstrated. The availability of computerized tomography (CT) scanning and/or magnetic resonance (MR) imaging as a diagnostic tool reduced the median period of symptoms prior to diagnosis by 6 months. Conclusions. Long-term overall survival significantly improved, but age-related differences in prognosis persisted. The increased sensitivity of the diagnostic method due to the availability of CT scanning and/or MR imaging may partly, but not entirely, account for the observed magnitude of improvement in overall survival. Thus local tumor treatment improved during the study period.

The predictive value of low–field strength magnetic resonance imaging for intraoperative residual tumor detection

2009 ◽  
Vol 111 (2) ◽  
pp. 252-257 ◽  
Author(s):  
Robert A. Hirschl ◽  
Jeff Wilson ◽  
Brandon Miller ◽  
Sergio Bergese ◽  
E. Antonio Chiocca
Keyword(s):  
Mr Imaging ◽  
Field Strength ◽  
Imaging System ◽  
Tumor Resection ◽  
High Strength ◽  
Residual Tumor ◽  
Intracranial Tumor ◽  
Resonance Imaging ◽  
Mr Images ◽  
Low Field

Object Neurosurgeons have been utilizing intraoperative MR (iMR) imaging to evaluate the extent of tumor resection since the 1990s. A low–field strength (0.12 T) MR imaging unit (PoleStar N20, Medtronic) is a practical and relatively inexpensive iMR imaging system that has found increased use in neurosurgery. The gold standard for postoperative detection of residual tumor has been high-strength MR imaging performed within 48 hours of resection. The object of this study was to determine the predictive concordance of low-strength iMR imaging with standard high-strength MR imaging for detection of residual tumor. Methods The authors retrospectively evaluated the MR images from 74 intracranial tumor resections, comparing the intraoperative images obtained using a 0.12-T iMR imaging unit to the immediate postoperative images obtained using a standard 1.5-T MR imaging unit within 48 hours after surgery. Results The sensitivity of low-field MR imaging for detection of residual tumor was 0.74 (95% CI 0.58–0.86), and its specificity was 0.97 (95% CI 0.83–1). When only glial tumors (42 of the 74 lesions) were analyzed, the sensitivity was 0.82 (95% CI 0.59–0.94) and the specificity was 0.95 (95% CI 0.73–1). Conclusions These data could assist the neurosurgeon who has to decide intraoperatively whether the observed iMR images show residual tumor or not.

scholarly journals A Gadolinium(III) Complex Based on the Thymine Nucleobase with Properties Suitable for Magnetic Resonance Imaging

2021 ◽  
Vol 22 (9) ◽  
pp. 4586
Author(s):  
Marta Orts-Arroyo ◽  
Amadeo Ten-Esteve ◽  
Sonia Ginés-Cárdenas ◽  
Isabel Castro ◽  
Luis Martí-Bonmatí ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Lesion Detection ◽  
Resonance Imaging ◽  
X Ray Diffraction ◽  
Functional Images ◽  
High Relaxivity ◽  
Contrast Enhanced ◽  
Phantom Studies

The paramagnetic gadolinium(III) ion is used as contrast agent in magnetic resonance (MR) imaging to improve the lesion detection and characterization. It generates a signal by changing the relaxivity of protons from associated water molecules and creates a clearer physical distinction between the molecule and the surrounding tissues. New gadolinium-based contrast agents displaying larger relaxivity values and specifically targeted might provide higher resolution and better functional images. We have synthesized the gadolinium(III) complex of formula [Gd(thy)2(H2O)6](ClO4)3·2H2O (1) [thy = 5-methyl-1H-pyrimidine-2,4-dione or thymine], which is the first reported compound based on gadolinium and thymine nucleobase. 1 has been characterized through UV-vis, IR, SEM-EDAX, and single-crystal X-ray diffraction techniques, and its magnetic and relaxometric properties have been investigated by means of SQUID magnetometer and MR imaging phantom studies, respectively. On the basis of its high relaxivity values, this gadolinium(III) complex can be considered a suitable candidate for contrast-enhanced magnetic resonance imaging.

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