Accuracy of stereotactic localisation with magnetic resonance compared to CT scan: experimental findings

Stereotactic Neuro-Navigation Phantom Designs: A Systematic Review

Diverse stereotactic neuro-navigation systems are used daily in neurosurgery and novel systems are continuously being developed. Prior to clinical implementation of new surgical tools, methods or instruments, in vitro experiments on phantoms should be conducted. A stereotactic neuro-navigation phantom denotes a rigid or deformable structure resembling the cranium with the intracranial area. The use of phantoms is essential for the testing of complete procedures and their workflows, as well as for the final validation of the application accuracy. The aim of this study is to provide a systematic review of stereotactic neuro-navigation phantom designs, to identify their most relevant features, and to identify methodologies for measuring the target point error, the entry point error, and the angular error (α). The literature on phantom designs used for evaluating the accuracy of stereotactic neuro-navigation systems, i.e., robotic navigation systems, stereotactic frames, frameless navigation systems, and aiming devices, was searched. Eligible articles among the articles written in English in the period 2000-2020 were identified through the electronic databases PubMed, IEEE, Web of Science, and Scopus. The majority of phantom designs presented in those articles provide a suitable methodology for measuring the target point error, while there is a lack of objective measurements of the entry point error and angular error. We identified the need for a universal phantom design, which would be compatible with most common imaging techniques (e.g., computed tomography and magnetic resonance imaging) and suitable for simultaneous measurement of the target point, entry point, and angular errors.

Variation assessment of deformable registration in stereotactic radiosurgery

INTRODUCTION

The regular functions of CT-MRI registration include delineation of targets and organs-at-risk (OARs) in radiosurgery planning. The question of whether deformable image registration (DIR) could be applied to stereotactic radiosurgery (SRS) in its place remains a subject of debate.

METHODS

This study collected data regarding 16 patients who had undergone single-fraction SRS treatment. All lesions were located close to the brainstem. CT and MRI two image sets were registered by both rigid image registration (RIR) and DIR algorithms. The contours of the OARs were drawn individually on the rigid and deformable CT-MRI image sets by qualified radiation oncologists and dosimetrists. The evaluation metrics included volume overlapping (VO), Dice similarity coefficient (DSC), and dose. The modified demons deformable algorithm (VARIAN SmartAdapt) was used for evaluation in this study.

RESULTS

The mean range of VO for OARs was 0.84 ± 0.08, and DSC was 0.82 ± 0.07. The maximum average volume difference was at normal brain (17.18 ± 14.48 cm³) and the second highest was at brainstem (2.26 cm³ ± 1.18). Pearson correlation testing showed that all DIRs' OAR volumes were linearly and significantly correlated with RIRs' volume (0.679-0.992, two tailed, P << 0.001). The 100% dose was prescribed at gross tumor volume (GTV). The average maximum percent dose difference was observed in brainstem (26.54% ± 27.027), and the average mean dose difference has found at same organ (1.6% ± 1.66).

CONCLUSION

The change in image-registration method definitely produces dose variance, and is significantly more what depending on the target location. The volume size of OARs, however, was not statistical significantly correlated with dose variance.

Volumetric accuracy of cone-beam computed tomography

Purpose

This study was performed to investigate the influence of object shape and distance from the center of the image on the volumetric accuracy of cone-beam computed tomography (CBCT) scans, according to different parameters of tube voltage and current.

Materials and Methods

Four geometric objects (cylinder, cube, pyramid, and hexagon) with predefined dimensions were fabricated. The objects consisted of Teflon-perfluoroalkoxy embedded in a hydrocolloid matrix (Dupli-Coe-Loid TM; GC America Inc., Alsip, IL, USA), encased in an acrylic resin cylinder assembly. An Alphard Vega Dental CT system (Asahi Roentgen Ind. Co., Ltd, Kyoto, Japan) was used to acquire CBCT images. OnDemand 3D (CyberMed Inc., Seoul, Korea) software was used for object segmentation and image analysis. The accuracy was expressed by the volume error (VE). The VE was calculated under 3 different exposure settings. The measured volumes of the objects were compared to the true volumes for statistical analysis.

Results

The mean VE ranged from −4.47% to 2.35%. There was no significant relationship between an object's shape and the VE. A significant correlation was found between the distance of the object to the center of the image and the VE. Tube voltage affected the volume measurements and the VE, but tube current did not.

Conclusion

The evaluated CBCT device provided satisfactory volume measurements. To assess volume measurements, it might be sufficient to use serial scans with a high resolution, but a low dose. This information may provide useful guidance for assessing volume measurements.

Hearing Outcomes After Stereotactic Radiosurgery for Vestibular Schwannomas : Mechanism of Hearing Loss and How to Preserve Hearing

The use of stereotactic radiosurgery (SRS) expanded to include the treatment of vestibular schwannomas (VSs) in 1969; since then, efforts to increase tumour control and to reduce cranial neuropathy have continued. Using the currently recommended marginal dose of 12-13 Gy, long-term reported outcomes after SRS include not only excellent tumour control rates of 92-100 % but also outstanding functional preservation of the trigeminal and facial nerves, with values of 92-100 % and 94-100 %, respectively. Nonetheless, hearing preservation remains in the range of 32-81 %. Previous studies have suggested possible prognostic factors of hearing preservation such as the Gardner-Robertson grade, radiation dose to the cochlea, transient volume expansion (TVE) after SRS, length of irradiated cochlear nerve, marginal dose to the tumour, and age. However, we still do not clearly understand why patients lose their hearing after SRS for VS.Relevant to these considerations, one study recently reported that the auditory brainstem response (ABR) wave V latency and waves I and V interval (IL_I-V) correlated well with intracanalicular pressure values and even with hearing level. The demonstration that ABR values, especially wave V latency and IL_I-V, correlate well with intracanalicular pressure suggests that patients with previously elevated intracanalicular pressure might have an increased chance of hearing loss on development of TVE, which has been recognised as a common phenomenon after SRS or stereotactic radiotherapy (SRT) for intracranial schwannomas.In our experience, the ABR IL_I-V increased during the first 12 months after SRS for VSs in patients who lost their serviceable hearing. The effect of increased ABR IL_I-V on hearing outcome also became significant over time, especially at 12 months after SRS, and was more prominent in patients with poor initial pure-tone average (PTA) and/or ABR values. We hypothesise that patients with considerable intracanalicular pressure at the time of SRS are prone to lose their serviceable hearing due to the added intracanalicular pressure induced by TVE, which usually occurs within the first 12 months after SRS for VSs. Using these findings, we suggested a classification system for the prediction of hearing outcomes after SRS for VSs. This classification system could be useful in the proper selection of management modalities for hearing preservation, especially in patients with only hearing ear schwannoma or neurofibromatosis type 2.Advances in diagnostic tools, treatment modalities, and optimisation of radiosurgical dose have improved clinical outcomes, including tumour control and cranial neuropathies, in patients with VSs. However, the preservation of hearing function still falls short of our expectation. A prediction model for hearing preservation after each treatment modality will guide the proper selection of treatment modalities and permit the appropriate timing of active treatment, which will lead to the preservation of hearing function in patients with VSs.

Continuous table acquisition MRI for radiotherapy treatment planning: distortion assessment with a new extended 3D volumetric phantom

PURPOSE

Accurate geometry is required for radiotherapy treatment planning (RTP). When considering the use of magnetic resonance imaging (MRI) for RTP, geometric distortions observed in the acquired images should be considered. While scanner technology and vendor supplied correction algorithms provide some correction, large distortions are still present in images, even when considering considerably smaller scan lengths than those typically acquired with CT in conventional RTP. This study investigates MRI acquisition with a moving table compared with static scans for potential geometric benefits for RTP.

METHODS

A full field of view (FOV) phantom (diameter 500 mm; length 513 mm) was developed for measuring geometric distortions in MR images over volumes pertinent to RTP. The phantom consisted of layers of refined plastic within which vitamin E capsules were inserted. The phantom was scanned on CT to provide the geometric gold standard and on MRI, with differences in capsule location determining the distortion. MRI images were acquired with two techniques. For the first method, standard static table acquisitions were considered. Both 2D and 3D acquisition techniques were investigated. With the second technique, images were acquired with a moving table. The same sequence was acquired with a static table and then with table speeds of 1.1 mm/s and 2 mm/s. All of the MR images acquired were registered to the CT dataset using a deformable B-spline registration with the resulting deformation fields providing the distortion information for each acquisition.

RESULTS

MR images acquired with the moving table enabled imaging of the whole phantom length while images acquired with a static table were only able to image 50%-70% of the phantom length of 513 mm. Maximum distortion values were reduced across a larger volume when imaging with a moving table. Increased table speed resulted in a larger contribution of distortion from gradient nonlinearities in the through-plane direction and an increased blurring of capsule images, resulting in an apparent capsule volume increase by up to 170% in extreme axial FOV regions. Blurring increased with table speed and in the central regions of the phantom, geometric distortion was less for static table acquisitions compared to a table speed of 2 mm/s over the same volume. Overall, the best geometric accuracy was achieved with a table speed of 1.1 mm/s.

CONCLUSIONS

The phantom designed enables full FOV imaging for distortion assessment for the purposes of RTP. MRI acquisition with a moving table extends the imaging volume in the z direction with reduced distortions which could be useful particularly if considering MR-only planning. If utilizing MR images to provide additional soft tissue information to the planning CT, standard acquisition sequences over a smaller volume would avoid introducing additional blurring or distortions from the through-plane table movement.

Assessment of spatial uncertainty in computed tomography-based Gamma Knife stereotactic radiosurgery process with automated positioning system

BACKGROUND

In this study, we assessed the geometric accuracy of an automated positioning system in Gamma Knife (GK) surgery. Specifically, we looked at the total spatial uncertainty over the entire treatment range of GK stereotactic radiosurgery (SRS) procedures in both the GK model C and the Perfexion (PFX).

METHODS

An originally-developed phantom and a radiochromic film were used for obtaining actual dose distributions. The phantom, with inserted films on different axial planes (z = 60, 75, 100, 125, 140 mm), sagittal planes (x = 60, 75, 100, 125, 140 mm), and coronal planes (y = 60, 75, 100, 125, 140 mm), was placed on a Leksell skull frame. Computed tomography (CT) was then performed with a stereotactic localizer box attached to the frame, and dose planning was made using the Leksell GammaPlan treatment planning system. The phantom finally received beam delivery using a single shot of a 4-mm collimator helmet. The discrepancy between the planned shot position and the irradiated center position was evaluated by a dedicated film analysis software.

RESULTS

The total uncertainty of CT-based GK SRS was less than 1 mm for almost all measured points over the stereotactic space in both the model C and the PFX. In addition, the geometric accuracy of the automated positioning system was estimated to be less than 0.1 mm and equal to 0.5 mm in the central and peripheral areas, respectively.

CONCLUSIONS

We confirmed that the total spatial uncertainties of both the GK model C and the PFX are acceptable for clinical use.

Accuracy of frame-based stereotactic magnetic resonance imaging vs frame-based stereotactic head computed tomography fused with recent magnetic resonance imaging for postimplantation deep brain stimulator lead localization

BACKGROUND

Introduction of the portable intraoperative CT scanner provides for a precise and cost-effective way of fusing head CT images with high-tesla MRI for the exquisite definition of soft tissue needed for stereotactic targeting.

OBJECTIVE

To evaluate the accuracy of stereotactic electrode placement in patients undergoing deep brain stimulation (DBS) by comparing frame-based postimplantation intraoperative CT (iCT) images fused to a recent 3T-MRI with frame-based postimplantation intraoperative MRI (iMRI) alone.

METHODS

Frame-based DBS surgeries of 46 targets performed from February 8, 2007 to April 28, 2008 in 26 patients with the use of immediate postimplantation iMRI for target localization were compared with frame-based immediate postimplantation iCT fused with a recent 3T brain MRI for DBS localization of 50 targets performed from August 13, 2008 to February 18, 2010 in 26 patients. Pre- and postoperative mid anterior commissure-posterior commissure line coordinates and XYZ coordinates for preoperatively calculated DBS targets (intended target) and for the permanent DBS lead tips were determined. The differences between preoperative DBS target and postoperative permanent DBS lead-tip coordinates based on postimplantation intraoperative MRI for the MRI-alone group and based on postimplantation intraoperative CT fused to recent preoperative MRI in the CT-MRI group were measured. The t test and Yuen test were used for comparison.

RESULTS

No statistically significant differences were found between the 2 groups when comparing the pre- and postperative changes in mid anterior commissure-posterior commissure line coordinates and XYZ coordinates.

CONCLUSION

Postimplantation DBS lead localization and therefore targeting accuracy was not significantly different between frame-based stereotactic 1.5T-MRI and frame-based stereotactic head CT fused with recent 3T-MRI.

Cortical visual evoked potentials recorded after optic tract near field stimulation during GPi-DBS in non-cooperative patients

OBJECT

Neurophysiologic monitoring during deep brain stimulation (DBS) interventions in the globus pallidus internum (Gpi) for the treatment of Parkinson's disease or primary dystonia is generally based upon microelectrode recordings (MER); moreover, MER request sophisticated technology and high level trained personnel for a reliable monitoring. Recordings of cortical visual evoked potentials (CVEPs) obtained after stimulation of the optic tract may be a potential option to MER; since optic tract lies just beneath the best target for Gpi DBS, changes in CVEPs during intraoperative exploration may drive a correct electrode positioning.

PATIENTS AND METHODS

Cortical VEPs from optic tract stimulation (OT C-CEPs) have been recorded in seven patients during GPi-DBS for the treatment of Parkinson's disease and primary dystonia under general sedation. OT C-VEPs were obtained after near-field monopolar stimulation of the optic tract; recording electrodes were at the scalp. Cortical responses after optic tract versus standard visual stimulation were compared.

RESULTS

After intraoperative near-field OT stimulation a biphasic wave, named N40-P70, was detected in all cases. N40-P70 neither change in morphology nor in latency at different depths, but increased in amplitude approaching the optic tract. The electrode tip was positioned just 1mm above the point where OT-CVEPs showed the larger amplitude. No MERs were obtained in these patients; OT CVEPs were the only method to detect the Gpi before positioning the electrodes.

CONCLUSIONS

OT CVEPs seem to be as reliable as MER to detail the optimal target in Gpi surgery: in addition they are less expensive, faster to perform and easier to decode.

A new coordinates system for cranial organs using magnetic resonance imaging

CONCLUSION

We developed a new coordinates system for magnetic resonance imaging (MRI) that utilizes the labyrinth and eyeballs as references to measure the spatial arrangement of cranial organs, and we verified its usefulness by observing small structures in the labyrinth in 39 ears from 33 patients. Our new coordinates system could be used for stereotactic analysis of cranial organs in MRI.

OBJECTIVES

To research semicircular canal anatomy in healthy organisms, we propose a method that employs references visible on MRI for stereotactic measurement of cranial structures, and we evaluated the usefulness of our method.

METHODS

Using the new coordinates system and vector analysis, we calculated angles among the semicircular canals and sagittal head plane from MRI volume data containing temporal bone and orbit.

RESULTS

The angle between the anterior semicircular canal plane and sagittal plane was 35.3 +/- 4.1 degrees; posterior semicircular canal plane and sagittal plane, 50.9 +/- 4.7 degrees; and horizontal semicircular canal plane and sagittal plane, 90.4 +/- 7.0 degrees. The angle between the anterior and posterior semicircular canal planes was 95.1 +/- 4.2 degrees; anterior and horizontal semicircular canal planes, 92.3 +/- 7.5 degrees; and posterior and horizontal semicircular canal planes, 93.5 +/- 4.9 degrees.

The role of imaging in the surgical treatment of movement disorders

Functional neurosurgery involves precise surgical targeting of anatomic structures to modulate neurologic function. From its conception, advances in the surgical treatment of movement disorders have been intertwined with developments in medical imaging, culminating in the use of stereotactic magnetic resonance imaging (MRI). Meticulous attention to detail during image acquisition, direct anatomic localization, and planning of the initial surgical trajectory allows the surgeon to reach the desired anatomic and functional target with the initial trajectory in most cases, thus reducing the need for multiple passes through the brain, and the associated risk of hemorrhage and functional deficit. This philosophy is of paramount importance in a procedure that is primarily aimed at improving quality of life. Documentation of electrode contact location by means of stereotactic imaging is essential to audit surgical targeting accuracy and to further the knowledge of structure-to-function relationships within the human brain.

Avoiding the ventricle: a simple step to improve accuracy of anatomical targeting during deep brain stimulation

OBJECT

The authors examined the accuracy of anatomical targeting during electrode implantation for deep brain stimulation in functional neurosurgical procedures. Special attention was focused on the impact that ventricular involvement of the electrode trajectory had on targeting accuracy.

METHODS

The targeting error during electrode placement was assessed in 162 electrodes implanted in 109 patients at 2 centers. The targeting error was calculated as the shortest distance from the intended stereotactic coordinates to the final electrode trajectory as defined on postoperative stereotactic imaging. The trajectory of these electrodes in relation to the lateral ventricles was also analyzed on postoperative images.

RESULTS

The trajectory of 68 electrodes involved the ventricle. The targeting error for all electrodes was calculated: the mean +/- SD and the 95% CI of the mean was 1.5 +/- 1.0 and 0.1 mm, respectively. The same calculations for targeting error for electrode trajectories that did not involve the ventricle were 1.2 +/- 0.7 and 0.1 mm. A significantly larger targeting error was seen in trajectories that involved the ventricle (1.9 +/- 1.1 and 0.3 mm; p < 0.001). Thirty electrodes (19%) required multiple passes before final electrode implantation on the basis of physiological and/or clinical observations. There was a significant association between an increased requirement for multiple brain passes and ventricular involvement in the trajectory (p < 0.01).

CONCLUSIONS

Planning an electrode trajectory that avoids the ventricles is a simple precaution that significantly improves the accuracy of anatomical targeting during electrode placement for deep brain stimulation. Avoidance of the ventricles appears to reduce the need for multiple passes through the brain to reach the desired target as defined by clinical and physiological observations.

A comparative evaluation of Cone Beam Computed Tomography (CBCT) and Multi-Slice CT (MSCT). Part II: On 3D model accuracy

AIM

The study aim was to compare the geometric accuracy of three-dimensional (3D) surface model reconstructions between five Cone Beam Computed Tomography (CBCT) scanners and one Multi-Slice CT (MSCT) system.

MATERIALS AND METHODS

A dry human mandible was scanned with five CBCT systems (NewTom 3G, Accuitomo 3D, i-CAT, Galileos, Scanora 3D) and one MSCT scanner (Somatom Sensation 16). A 3D surface bone model was created from the six systems. The reference (gold standard) 3D model was obtained with a high resolution laser surface scanner. The 3D models from the five systems were compared with the gold standard using a point-based rigid registration algorithm.

RESULTS

The mean deviation from the gold standard for MSCT was 0.137 mm and for CBCT were 0.282, 0.225, 0.165, 0.386 and 0.206 mm for the i-CAT, Accuitomo, NewTom, Scanora and Galileos, respectively.

CONCLUSION

The results show that the accuracy of CBCT 3D surface model reconstructions is somewhat lower but acceptable comparing to MSCT from the gold standard.

Accuracy and repeatability of cone-beam computed tomography (CBCT) measurements used in the determination of facial indices in the laboratory setup

AIM

To assess the three dimensional (3D) surface accuracy of a phantom's face acquired from a cone-beam computed tomography (CBCT) scan and to determine the reliability of selected cephalometric measurements performed with Maxilim software (Medicim N.V., Mechelen, Belgium).

MATERIAL AND METHODS

A mannequin head was imaged with a CBCT (I-CAT, Imaging Sciences International, Inc., Hatfield, USA). The data were used to produce 3D surface meshes (Maxilim and Mimics, Materialise N.V., Leuven, Belgium) which were compared with an optical surface scan of the head using Focus Inspection software (Metris N.V., Leuven, Belgium). The intra- and inter-observer reliability for the measurement of distances between facial landmarks with Maxilim 3D cephalometry were determined by calculating Pearson correlation coefficients and intraclass correlation (ICC). The Dahlberg formula was used to assess the method error (ME).

RESULTS

(1) The maximal range of the 3D mesh deviations was 1.9 mm for Maxilim, and 1.8mm for Mimics segmentation. (2) Test-retest and inter-observer reliability were high; Pearson's correlation coefficient was 1.000 and the ICC was 0.9998. The ME of the vertical measurements was a little larger than that calculated for the width measurements. Maximum ME was 1.33 mm.

CONCLUSIONS

The 3D surface accuracy of CBCT scans segmented with Maxilim and Mimics software is high. Maxilim also shows satisfactory intra- and inter-assessor reliability for measurement of distances on a rigid facial surface.

Geometric accuracy of a newly developed cone-beam device for maxillofacial imaging

OBJECTIVE

The aim of this study was to determine the geometric accuracy of scans obtained with a newly developed cone-beam computed tomography (CBCT) device in comparison with a multidetector row computed tomography (MDCT) scanner.

STUDY DESIGN

Cone-beam scans were obtained with the preretail version of a newly developed compact size device with a scan volume of 15 x 15 x 15 cm. Conventional CT scans for comparison were performed with a 6-detector row CT scanner. To determine distance accuracy, 100 measurements were performed on radiopaque markers on a dry human skull. To determine volume accuracy, 25 measurements were carried out on a geometric phantom. Commercially available software was used for three-dimensional visualization and measurements on imaging data.

RESULTS

Mean absolute measurement error (AME) for linear distances was 0.26 mm (+/-0.18 mm) for the CBCT device and 0.18 mm (+/-0.17 mm) for the MDCT device (P = .196 in paired t test). The average absolute percentage error (APE) was 0.98% (+/-0.73%) and 1.26% (+/-1.50%), respectively (P = .485 in paired t test). Linear regression analysis showed a positive correlation between AME and distance length (R = 0.628; P = .004) for CBCT-based measurements. Average AME in volume measurements was 1.78 mL (+/-0.99 mL) for the CBCT device and 1.23 mL (+/-0.93 mL) for the MDCT device. The average APE was 6.01% (+/-1.49%) and 4.42% (+/-1.99%), respectively.

CONCLUSIONS

The results indicate that the evaluated cone-beam device provides satisfactory information about linear distances and volumes. Multidetector row computed tomography scans proved slightly more accurate in both measurement categories. The difference may be considered as not relevant for the majority of clinical applications.

Anatomical identification of active contacts in subthalamic deep brain stimulation

BACKGROUND

Subthalamic Deep Brain Stimulation is a valid surgical procedure for the treatment of idiopathic PD, although its precise mechanism of action is still unclear; moreover, there are no conclusive data about the functional anatomy of the human subthalamic region. Identifying the location of active contacts for StnDBS can yield interesting insights on the mechanisms of action of DBS and the different role played by the anatomical structures of the subthalamic region.

METHODS

Twenty-five patients operated on for bilateral StnDBS were considered. During the surgical procedure, a complete intraoperative neurophysiological study was obtained by means of semimicrorecordings and stimulations. After surgery, an MRI study confirmed the position of the electrodes; MR images were subsequently superimposed onto a stereotactic atlas by using a dedicated workstation. The coordinates relative to the tip of the electrodes and active contacts were then calculated.

RESULTS

Most of the electrode tips are located inside the subthalamus or immediately ventrally to it. Of the active contacts used for chronic stimulation, 96.5% are located in a well-defined anatomical region, which includes subthalamus, zona incerta, and FF.

CONCLUSIONS

Our findings seem to suggest that other structures beyond the subthalamus itself play a clinical role in symptoms control after DBS for PD.

3-D measurement of body tissues based on ultrasound images with 3-D spatial information

In this study, we developed a new method to perform 3-D measurements between the recorded B-scans using the corresponding spatial location and orientation of each B-scan, without the need to create a 3-D volume. A portable ultrasound (US) scanner and an electromagnetic spatial locator attached to the US probe were used. During data collection, the US probe was moved over the region-of-interest. A small number of B-scans containing interesting anatomical information were captured from different body parts and displayed in a 3-D space with their corresponding locations recorded by the spatial locator. In the B-scan planes, the distance between any two points, as well as the angle between any two lines, could be calculated. In validation experiments, three distances and three angles of a custom-designed phantom were measured using this method. In comparison with the results measured by a micrometer, the mean error of distance measurement was -0.8 +/- 1.7 mm (-2.3 +/- 3.6%) and that of angle measurement was -0.3 +/- 2.9 degrees (-0.1 +/- 4.1%). The lengths of the first metatarsals and the angles between the first metatarsals and the middle part of the tibias of three subjects were measured in vivo using magnetic resonance imaging (MRI) and the US method by two operators before and after MRI scanning. The overall percentage differences of the length and angle measurements were 0.8 +/- 2.2% and 2.5 +/- 3.6%, respectively. The results showed that this US method had good repeatability and reproducibility (interclass correlation coefficient values > 0.75). We expect that this new method could potentially provide a quick and effective approach for the 3-D measurement of soft tissues and bones in the musculoskeletal system.

Geometric accuracy of magnetic resonance imaging of the mandibular nerve

OBJECTIVES

Magnetic resonance imaging (MRI) is not routinely used for dental implant planning. A prerequisite for dental implant planning is the accurate imaging of risk structures like the mandibular nerve. The geometric accuracy of the imaging of the mandibular nerve was investigated.

METHODS

Two human cadaver heads were scanned using MRI. Computed tomography (CT) scans of the same heads were used as a benchmark. Using a stereotactic frame, corresponding images of MRI and CT were superimposed and the concordance of the images of the mandibular nerve in MRI with those of the mandibular canal in CT was assessed.

RESULTS

The geometric accuracy of the mandibular nerve in MRI was as good as that of the mandibular canal in CT imaging.

CONCLUSIONS

MRI of the mandibular nerve is sufficiently accurate for the use of this imaging method in dental implant planning.

Analyzing 3-tesla magnetic resonance imaging units for implementation in radiosurgery

OBJECT

The limiting factor affecting accuracy during gamma knife surgery is image quality. The new generation of magnetic resonance (MR) imaging units with field strength up to 3 teslas promise superior image quality for anatomical resolution and contrast. There are, however, questions about chemical shifts or susceptibility effects, which are the subject of this paper.

METHODS

The 3-tesla MR imaging unit (Siemens Trio) was analyzed and compared with a 1-tesla unit (Siemens Magnetom Expert) and to a 1.5-tesla unit (Philips Gyroscan). Evaluation of the magnitude of error was performed within transverse slices in two orientations (axial/coronal) by using a cylindrical phantom with an embedded grid. Deviations were determined for 21 targets in a slab phantom with known geometrical positions within the stereotactic frame. Distortions caused by chemical shift and/or susceptibility effects were analyzed in a head phantom. Inhouse software was used for data analyses. The mean deviation was less than 0.3 mm in axial and less than 0.4 mm in coronal orientations. For the known targets the maximum deviation was 1.16 mm. By optimizing these parameters in the protocol these inaccuracies could be reduced to less than 1.1 mm. Due to inhomogeneities a shift in the z direction of up to 1.5 mm was observed for a dataset, which was shown to be compressed by 1.2 mm.

CONCLUSIONS

The 3-tesla imaging unit showed superior anatomical contrast and resolution in comparison with the established 1-tesla and 1.5-tesla units; however, due to the high field strength the field within the head coil is very sensitive to inhomogeneities and therefore 3-tesla imaging data will have be handled with care.

Analyzing 3-tesla magnetic resonance imaging units for implementation in radiosurgery

Object. The limiting factor affecting accuracy during gamma knife surgery is image quality. The new generation of magnetic resonance (MR) imaging units with field strength up to 3 teslas promise superior image quality for anatomical resolution and contrast. There are, however, questions about chemical shifts or susceptibility effects, which are the subject of this paper.

Methods. The 3-tesla MR imaging unit (Siemens Trio) was analyzed and compared with a 1-tesla unit (Siemens Magnetom Expert) and to a 1.5-tesla unit (Philips Gyroscan). Evaluation of the magnitude of error was performed within transverse slices in two orientations (axial/coronal) by using a cylindrical phantom with an embedded grid. Deviations were determined for 21 targets in a slab phantom with known geometrical positions within the stereotactic frame. Distortions caused by chemical shift and/or susceptibility effects were analyzed in a head phantom. Inhouse software was used for data analyses.

The mean deviation was less than 0.3 mm in axial and less than 0.4 mm in coronal orientations. For the known targets the maximum deviation was 1.16 mm. By optimizing these parameters in the protocol these inaccuracies could be reduced to less than 1.1 mm. Due to inhomogeneities a shift in the z direction of up to 1.5 mm was observed for a dataset, which was shown to be compressed by 1.2 mm.

Conclusions. The 3-tesla imaging unit showed superior anatomical contrast and resolution in comparison with the established 1-tesla and 1.5-tesla units; however, due to the high field strength the field within the head coil is very sensitive to inhomogeneities and therefore 3-tesla imaging data will have be handled with care.

Stereotactic MR imaging for planning neural transplantation: a reliable technique at 3 Tesla?

The purpose of this study was to assess the accuracy of high field (3 Tesla) MR in target localization for stem cell transplantation. Three patients with Huntington's disease were imaged with a stereotactic frame in place for both MRI and CT. Quality assurance procedures and manual shimming were performed before each MRI study to minimize image distortion. The images were fused using multi-modality rigid body image registration software. Image fusion demonstrated the MR images to be in agreement with CT to within 1.5 mm, as assessed by measuring the coordinates of markers on the frame and on the shape and size of the lateral ventricles. Target coordinates for transplantation were selected from the MR images. Postoperative imaging confirmed accurate graft placement.

Stereotactic target localization accuracy in interventional magnetic resonance imaging

OBJECTIVE

To compare stereotactic target determination, based on images obtained from interventional MRI (iMRI), conventional closed MR and CT.

METHODS

Stereotactic coordinates for 55 targets in an artificial scull were derived from iMRI scans and compared using CT as the standard. Stereotactic coordinates were also derived from iMRI scans in a series of patients and compared using iMRI fused with CT as the standard.

RESULTS

The mean difference between targets in the skull phantom determined from iMRI and CT images was 0.90 +/- 0.28 mm, with a maximum difference of 1.57 mm. The mean difference between targets in the patients derived from iMRI alone and interventional MR fused with CT was 1.39 +/- 0.54 mm, with a maximum difference of 2.47 mm.

DISCUSSION

The results indicate that iMRI can be used for stereotactic target localization.

Effect of subpixel magnetic resonance imaging shifts on radiosurgical dosimetry for vestibular schwannoma

Object. The purpose of this study was to evaluate subpixel magnetic resonance (MR) imaging shifts of intracanalicular vestibular schwannomas (VSs) with respect to the internal auditory canal (IAC) as documented on computerized tomography (CT) scanning and to investigate the source of imaging-related localization errors in radiosurgery as well as the effect of such shifts on the dosimetry for small targets.

Methods. A shift of the stereotactic coordinates of intracanalicular VSs between those determined on MR imaging and those on CT scanning represents an error in localization. A shift vector places the tumor within the IAC and measures the CT scan/MR image discrepancy. The shift vectors were measured in a series of 15 largely intracanalicular VSs (all < 1.5 cm3 in volume). Using dose volume histogram measurements, the overlap between shifted and unshifted tumors and radiosurgical treatment plans were measured. Using plastic and bone phantoms and thermoluminescent dosimetry measurements, the correspondence between CT and MR imaging targets and treatments delivered using the Leksell gamma knife were measured. Combining these measurements, the correspondence between intended and actual treatments was measured.

Conclusions. The delivery of radiation to CT-imaged targets was accurate to the limits of measurement (∼ 0.1 mm). The MR imaging shifts seen in the y axis averaged 0.9 mm and in the z axis 0.8 mm. The corresponding percentage of tumor coverage with respect to apparent target shift decreased from 98 to 77%. This represents a significant potential error when targets are defined solely by MR imaging.

Intraoperative magnetic resonance imaging and magnetic resonance imaging-guided therapy for brain tumors

Since their introduction into surgical practice in the mid 1990s, intraoperative MRI systems have evolved into essential, routinely used tools for the surgical treatment of brain tumors in many centers. Clear delineation of the lesion, "under-the-surface" vision, and the possibility of obtaining real-time feedback on the extent of resection and the position of residual tumor tissue (which may change during surgery due to "brain-shift") are the main strengths of this method. High-performance computing has further extended the capabilities of intraoperative MRI systems, opening the way for using multimodal information and 3D anatomical reconstructions, which can be updated in "near real time." MRI sensitivity to thermal changes has also opened the way for innovative, minimally invasive (LASER ablations) as well as noninvasive therapeutic approaches for brain tumors (focused ultrasound). Although we have not used intraoperative MRI in clinical applications sufficiently long to assess long-term outcomes, this method clearly enhances the ability of the neurosurgeon to navigate the surgical field with greater accuracy, to avoid critical anatomic structures with greater efficacy, and to reduce the overall invasiveness of the surgery itself.