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Rogers CM, Jones PS, Weinberg JS. Intraoperative MRI for Brain Tumors. J Neurooncol 2021; 151:479-490. [PMID: 33611714 DOI: 10.1007/s11060-020-03667-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The use of intraoperative imaging has been a critical tool in the neurosurgeon's armamentarium and is of particular benefit during tumor surgery. This article summarizes the history of its development, implementation, clinical experience and future directions. METHODS We reviewed the literature focusing on the development and clinical experience with intraoperative MRI. Utilizing the authors' personal experience as well as evidence from the literature, we present an overview of the utility of MRI during neurosurgery. RESULTS In the 1990s, the first description of using a low field MRI in the operating room was published describing the additional benefit provided by improved resolution of MRI as compared to ultrasound. Since then, implementation has varied in magnetic field strength and in configuration from floor mounted to ceiling mounted units as well as those that are accessible to the operating room for use during surgery and via an outpatient entrance to use for diagnostic imaging. The experience shows utility of this technique for increasing extent of resection for low and high grade tumors as well as preventing injury to important structures while incorporating techniques such as intraoperative monitoring. CONCLUSION This article reviews the history of intraoperative MRI and presents a review of the literature revealing the successful implementation of this technology and benefits noted for the patient and the surgeon.
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Affiliation(s)
- Cara Marie Rogers
- Department of Neurosurgery, Virginia Tech Carilion, Roanoke, VA, USA
| | - Pamela S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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Rashid S, Han F, Gao Y, Sung K, Cao M, Yang Y, Hu P. Cardiac balanced steady-state free precession MRI at 0.35 T: a comparison study with 1.5 T. Quant Imaging Med Surg 2018; 8:627-636. [PMID: 30211030 DOI: 10.21037/qims.2018.08.09] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background While low-field MRI is disadvantaged by a reduced signal-to-noise ratio (SNR) compared to higher fields, it has a number of useful features such as decreased SAR and shorter T1, and has shown promise for diagnostic imaging. This study demonstrates the feasibility of cardiac balanced steady-state free precession (bSSFP) MRI at 0.35 T and compares cardiac bSSFP MRI images at 0.35 T with those at 1.5 T. Methods Cardiac images were acquired in 7 healthy volunteers using an ECG-gated bSSFP cine sequence on a 0.35 T superconducting MR system as well as a clinical 1.5 T system. Blood and myocardium SNR and contrast-to-noise ratio (CNR) were computed. Subjective image scoring was used to compare the image quality between 0.35 and 1.5 T. Results Cardiac images at 0.35 T were successfully acquired in all volunteers. While the 0.35 T images were noisier than those at 1.5 T, blood, myocardium and papillary muscles could be clearly delineated. At 0.35 T, bSSFP images were acquired at flip angles as high as 150°. Maximum CNR was achieved at 130°. Image quality scoring showed that while at lower flip angles, the 0.35 T images had poorer quality than the 1.5 T, but with flip angles of 110 and 130, the image quality at 0.35 T had scores similar to those at 1.5 T. Conclusions This study demonstrates that cardiac bSSFP imaging is highly feasible at 0.35 T.
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Affiliation(s)
- Shams Rashid
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Fei Han
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yu Gao
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine Inter-Departmental Program, University of California, Los Angeles, CA, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine Inter-Departmental Program, University of California, Los Angeles, CA, USA
| | - Minsong Cao
- Physics and Biology in Medicine Inter-Departmental Program, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yingli Yang
- Physics and Biology in Medicine Inter-Departmental Program, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine Inter-Departmental Program, University of California, Los Angeles, CA, USA
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Burkhardt JK, Neidert MC, Woernle CM, Bozinov O, Bernays RL. Intraoperative low-field MR-guided frameless stereotactic biopsy for intracerebral lesions. Acta Neurochir (Wien) 2013; 155:721-6. [PMID: 23435865 DOI: 10.1007/s00701-013-1639-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND To present our intraoperative low-field magnetic resonance imaging (ioMRI) technique for stereotactic brain biopsy in various intracerebral lesions. METHOD Seventy-eight consecutive patients underwent stereotactic biopsies with the PoleStar N-20/N-30 ioMRI system and data were evaluated retrospectively. Biopsy technique included ioMRI before surgery, followed by insertion of the biopsy cannula in the lesion, and ioMRI before and after biopsy. Statistical analysis was performed to compare subgroups using Excel and SPSS statistic software. RESULTS In all patients, stereotactic biopsy was possible, with a mean intraoperative surgery time of 86.2 ± 28.6 min and a mean hospital stay of 11.6 ± 4.6 days. In 97.4 % (n = 76), histology was conclusive, representing 58 brain tumors and 18 other pathologies. Five patients were biopsied previously without conclusive diagnosis, and all biopsies were conclusive this time. Mean cross-sectional lesion size in MRI T1 with contrast (n = 64) was 6.9 ± 5.7 cm(2), and in lesions without T1 contrast enhancement (n = 14), T2 mean cross-sectional lesion size was 5.5 ± 3.9 cm(2). Mean distance from the cortex surface to the lesion was 3.4 ± 1.2 cm. One patient suffered from a postoperative wound dehiscence; neither clinically or radiologically significant hemorrhage after surgery, nor intraoperative complications occurred. CONCLUSIONS Low-field ioMR-guided frameless stereotactic biopsy accurately diagnosed different intracerebral lesions without major complications for the patients, and within an acceptable surgery time and hospital stay. In repeated non-conclusive biopsies in particular, low-field ioMRI offers a technique for arriving at a diagnosis.
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Martin XP, Vaz G, Fomekong E, Cosnard G, Raftopoulos C. Intra-operative 3.0 T Magnetic Resonance Imaging Using a Dual-Independent Room: Long-Term Evaluation of Time-Cost, Problems, and Learning-Curve Effect. INTRAOPERATIVE IMAGING 2011; 109:139-44. [DOI: 10.1007/978-3-211-99651-5_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Viard R. Présentation des différentes avancées techniques en imagerie interventionnelle par résonance magnétique. Ing Rech Biomed 2009. [DOI: 10.1016/j.irbm.2008.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Szelényi A, Gasser T, Seifert V. Intraoperative Neurophysiological Monitoring in an Open Low-field Magnetic Resonance Imaging System: Clinical Experience and Technical Considerations. Oper Neurosurg (Hagerstown) 2008; 63:268-75; discussion 275-6. [DOI: 10.1227/01.neu.0000310705.72487.f9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
Objective:
The intraoperative combination of an open magnetic resonance imaging (MRI) system with neurophysiological localization and continuous monitoring techniques allows for the best available anatomic and physiological orientation as well as real-time functional monitoring. Methodological aspects and technical adaptations for this combination of methods and the experience in 29 patients with tumors in the central region are reported.
Methods:
MRI-compatible platinum/iridium electrodes for intraoperative neuromonitoring were attached to the patient’s head. All other electrodes located outside the magnet were stainless steel needle-electrodes for recording of motor evoked potentials and for stimulating somatosensory evoked potentials. Intraoperative MRI was performed using a 0.15-T intraoperative magnetic resonance scanner (PoleStar N20; Medtronic Surgical Navigation Technologies, Louisville, KY).
Results:
The calculated and measured values of the maximum induced magnetic field (2 × 10−6T), induced voltage (0.1 V), and force (0.01 N) by the static or changing magnetic field within all attached electrodes were negligible and proved the method’s safety. In 29 patients, platinum/iridium electrodes with low susceptibility showed no interference with the imaging quality. Furthermore, neurophysiological monitoring could be performed with unaffected recording quality. Side effects (e.g., thermal induction) were not observed.
Conclusion:
Neurophysiological monitoring for evoked potentials and direct cortical stimulation can be performed with standard quality within a low-field intraoperative MRI system. Electrodes fixed to the head should be of low magnetic susceptibility to guarantee optimal imaging quality. The combined use of an open ultra low-field MRI system and intraoperative monitoring allows for resection control and continuous functional monitoring.
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Affiliation(s)
- Andrea Szelényi
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
| | - Thomas Gasser
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
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Ntoukas V, Krishnan R, Seifert V. THE NEW GENERATION POLESTAR N20 FOR CONVENTIONAL NEUROSURGICAL OPERATING ROOMS. Oper Neurosurg (Hagerstown) 2008; 62:82-9; discussion 89-90. [DOI: 10.1227/01.neu.0000317376.38067.8e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Viard R, Rousseau J. [Interventional MR imaging: state of the art and technological advances]. JOURNAL DE RADIOLOGIE 2008; 89:13-20. [PMID: 18288022 DOI: 10.1016/s0221-0363(08)70365-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Due to its excellent soft tissue contrast and lack of ionizing radiation, MR imaging is well suited for interventional procedures. MRI is being increasingly used for guidance during percutaneous procedures or surgery. Technical advances in interventional MR imaging are reviewed in this paper. Ergonomical factors with improved access to patients as well as advances in informatics, electronics and robotics largely explain this increasing role. Different elements are discussed from improved access to patients in the scanners to improved acquisition pulse sequences. Selected clinical applications and recent publications will be presented to illustrate the current status of this technique.
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Affiliation(s)
- R Viard
- INSERM, U703, ITM, Pavillon Vancostenobel, CHRU de Lille, 2 avenue Oscar Lambret, 59000 Lille Cedex.
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