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Jellema PEJ, Mannsdörfer LM, Visser F, De Luca A, Smit CLE, Hoving EW, van Baarsen KM, Lindner T, Mutsaerts HJMM, Dankbaar JW, Lequin MH, Wijnen JP. Improving advanced intraoperative MRI methods during pediatric neurosurgery. NMR IN BIOMEDICINE 2024; 37:e5124. [PMID: 38403798 DOI: 10.1002/nbm.5124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
Advanced intraoperative MR images (ioMRI) acquired during the resection of pediatric brain tumors could offer additional physiological information to preserve healthy tissue. With this work, we aimed to develop a protocol for ioMRI with increased sensitivity for arterial spin labeling (ASL) and diffusion MRI (dMRI), optimized for patient positioning regularly used in the pediatric neurosurgery setting. For ethical reasons, ASL images were acquired in healthy adult subjects that were imaged in the prone and supine position. After this, the ASL cerebral blood flow (CBF) was quantified and compared between both positions. To evaluate the impact of the RF coils setups on image quality, we compared different setups (two vs. four RF coils) by looking at T1-weighted (T1w) signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), as well as undertaking a qualitative evaluation of T1w, T2w, ASL, and dMR images. Mean ASL CBF did not differ between the surgical prone and supine positions in any of the investigated regions of interest or the whole brain. T1w SNR (gray matter: p = 0.016, 34% increase; white matter: p = 0.016, 32% increase) and CNR were higher (p = 0.016) in the four versus two RF coils setups (18.0 ± 1.8 vs. 13.9 ± 1.8). Qualitative evaluation of T1w, T2w, ASL, and dMR images resulted in acceptable to good image quality and did not differ statistically significantly between setups. Only the nonweighted diffusion image maps and corticospinal tract reconstructions yielded higher image quality and reduced susceptibility artifacts with four RF coils. Advanced ioMRI metrics were more precise with four RF coils as the standard deviation decreased. Taken together, we have investigated the practical use of advanced ioMRI during pediatric neurosurgery. We conclude that ASL CBF quantification in the surgical prone position is valid and that ASL and dMRI acquisition with two RF coils can be performed adequately for clinical use. With four versus two RF coils, the SNR of the images increases, and the sensitivity to artifacts reduces.
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Affiliation(s)
- Pien E J Jellema
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lilli M Mannsdörfer
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Fredy Visser
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
- Philips HealthCare, Best, The Netherlands
| | - Alberto De Luca
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cynthia L E Smit
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Eelco W Hoving
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Kirsten M van Baarsen
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Thomas Lindner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Henk-Jan M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maarten H Lequin
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jannie P Wijnen
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
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Wu O, Clift GW, Hilliard S, Ip M. Evaluating the use of intraoperative magnetic resonance imaging in paediatric brain tumour resection surgeries: a literature review. J Med Radiat Sci 2023; 70:479-490. [PMID: 37434551 PMCID: PMC10715358 DOI: 10.1002/jmrs.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/02/2023] [Indexed: 07/13/2023] Open
Abstract
Brain tumours are the most common solid neoplasm in children, posing a significant challenge in oncology due to the limited range of treatment. Intraoperative magnetic resonance imaging (iMRI) has recently emerged to aid surgical intervention in neurosurgery resection with the potential to delineate tumour boundaries. This narrative literature review aimed to provide an updated evaluation of the clinical implementation of iMRI in paediatric neurosurgical resection, with an emphasis on the extent of brain tumour resection, patient outcomes and its drawbacks. Databases including MEDLINE, PubMed, Scopus and Web of Science were used to investigate this topic with key terms: paediatric, brain tumour, and iMRI. Exclusion criteria included literature comprised of adult populations and the use of iMRI in neurosurgery in the absence of brain tumours. The limited body of research evaluating the clinical implementation of iMRI in paediatric cohorts has been predominantly positive. Current evidence demonstrates the potential for iMRI use to increase rates of gross total resection (GTR), assess the extent of resection, and improve patient outcomes, such as progression-free survival. Limitations regarding the use of iMRI include prolonged operation times and complications associated with head immobilisation devices. iMRI has the potential to aid in the achievement of maximal brain tumour resection in paediatric patients. Future prospective randomised controlled trials are necessary to determine the clinical significance and benefits of using iMRI during neurosurgical resection for clinical management of brain neoplasms in children.
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Affiliation(s)
- Olivia Wu
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Georgina Williamson Clift
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Sonia Hilliard
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Miranda Ip
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
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Jellema PEJ, Wijnen JP, De Luca A, Mutsaerts HJMM, Obdeijn IV, van Baarsen KM, Lequin MH, Hoving EW. Advanced intraoperative MRI in pediatric brain tumor surgery. Front Physiol 2023; 14:1098959. [PMID: 37123260 PMCID: PMC10134397 DOI: 10.3389/fphys.2023.1098959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction: In the pediatric brain tumor surgery setting, intraoperative MRI (ioMRI) provides "real-time" imaging, allowing for evaluation of the extent of resection and detection of complications. The use of advanced MRI sequences could potentially provide additional physiological information that may aid in the preservation of healthy brain regions. This review aims to determine the added value of advanced imaging in ioMRI for pediatric brain tumor surgery compared to conventional imaging. Methods: Our systematic literature search identified relevant articles on PubMed using keywords associated with pediatrics, ioMRI, and brain tumors. The literature search was extended using the snowball technique to gather more information on advanced MRI techniques, their technical background, their use in adult ioMRI, and their use in routine pediatric brain tumor care. Results: The available literature was sparse and demonstrated that advanced sequences were used to reconstruct fibers to prevent damage to important structures, provide information on relative cerebral blood flow or abnormal metabolites, or to indicate the onset of hemorrhage or ischemic infarcts. The explorative literature search revealed developments within each advanced MRI field, such as multi-shell diffusion MRI, arterial spin labeling, and amide-proton transfer-weighted imaging, that have been studied in adult ioMRI but have not yet been applied in pediatrics. These techniques could have the potential to provide more accurate fiber tractography, information on intraoperative cerebral perfusion, and to match gadolinium-based T1w images without using a contrast agent. Conclusion: The potential added value of advanced MRI in the intraoperative setting for pediatric brain tumors is to prevent damage to important structures, to provide additional physiological or metabolic information, or to indicate the onset of postoperative changes. Current developments within various advanced ioMRI sequences are promising with regard to providing in-depth tissue information.
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Affiliation(s)
- Pien E. J. Jellema
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, Netherlands
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, Netherlands
- *Correspondence: Pien E. J. Jellema,
| | - Jannie P. Wijnen
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Alberto De Luca
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Henk J. M. M. Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands
| | - Iris V. Obdeijn
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Kirsten M. van Baarsen
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, Netherlands
- Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Maarten H. Lequin
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, Netherlands
- Department of Radiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Eelco W. Hoving
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, Netherlands
- Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, Netherlands
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Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci 2022; 21:148-167. [PMID: 34880193 PMCID: PMC9199972 DOI: 10.2463/mrms.rev.2021-0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.
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Affiliation(s)
- Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
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Voglis S, Hiller A, Hofer AS, Tosic L, Bozinov O, Regli L, Serra C. Failure of diffusion-weighted imaging in intraoperative 3 Tesla MRI to identify hyperacute strokes during glioma surgery. Sci Rep 2021; 11:16137. [PMID: 34373505 PMCID: PMC8352886 DOI: 10.1038/s41598-021-95505-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/21/2021] [Indexed: 12/02/2022] Open
Abstract
Intraoperatively acquired diffusion-weighted imaging (DWI) sequences in cranial tumor surgery are used for early detection of ischemic brain injuries, which could result in impaired neurological outcome and their presence might thus influence the neurosurgeon’s decision on further resection. The phenomenon of false-negative DWI findings in intraoperative magnetic resonance imaging (ioMRI) has only been reported in single cases and therefore yet needs to be further analyzed. This retrospective single-center study’s objective was the identification and characterization of false-negative DWI findings in ioMRI with new or enlarged ischemic areas on postoperative MRI (poMRI). Out of 225 cranial tumor surgeries with intraoperative DWI sequences, 16 cases with no additional resection after ioMRI and available in-time poMRI (< 14 days) were identified. Of these, a total of 12 cases showed false-negative DWI in ioMRI (75%). The most frequent tumor types were oligodendrogliomas and glioblastomas (4 each). In 5/12 cases (41.7%), an ischemic area was already present in ioMRI, however, volumetrically increased in poMRI (mean infarct growth + 2.1 cm3; 0.48–3.6), whereas 7 cases (58.3%) harbored totally new infarcts on poMRI (mean infarct volume 0.77 cm3; 0.05–1.93). With this study we provide the most comprehensive series of false-negative DWI findings in ioMRI that were not followed by additional resection. Our study underlines the limitations of intraoperative DWI sequences for the detection and size-estimation of hyperacute infarction. The awareness of this phenomenon is crucial for any neurosurgeon utilizing ioMRI.
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Affiliation(s)
- Stefanos Voglis
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Aimee Hiller
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Anna-Sophie Hofer
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Lazar Tosic
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Luca Regli
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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Voglis S, Müller T, van Niftrik CHB, Tosic L, Neidert MC, Regli L, Bozinov O. Impact of additional resection on new ischemic lesions and their clinical relevance after intraoperative 3 Tesla MRI in neuro-oncological surgery. Neurosurg Rev 2020; 44:2219-2227. [PMID: 32996078 PMCID: PMC8338811 DOI: 10.1007/s10143-020-01399-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
Intraoperative MRI (ioMRI) has become a frequently used tool to improve maximum safe resection in brain tumor surgery. The usability of intraoperatively acquired diffusion-weighted imaging sequences to predict the extent and clinical relevance of new infarcts has not yet been studied. Furthermore, the question of whether more aggressive surgery after ioMRI leads to more or larger infarcts is of crucial interest for the surgeons' operative strategy. Retrospective single-center analysis of a prospective registry of procedures from 2013 to 2019 with ioMRI was used. Infarct volumes in ioMRI/poMRI, lesion localization, mRS, and NIHSS were analyzed for each case. A total of 177 individual operations (60% male, mean age 45.5 years old) met the inclusion criteria. In 61% of the procedures, additional resection was performed after ioMRI, which resulted in a significantly higher number of new ischemic lesions postoperatively (p < .001). The development of new or enlarged ischemic areas upon additional resection could also be shown volumetrically (mean volume in ioMRI 0.39 cm3 vs. poMRI 2.97 cm3; p < .001). Despite the surgically induced new infarcts, mRS and NIHSS did not worsen significantly in cases with additional resection. Additionally, new perilesional ischemia in eloquently located tumors was not associated with an impaired neurological outcome. Additional resection after ioMRI leads to new or enlarged ischemic areas. However, these new infarcts do not necessarily result in an impaired neurological outcome, even when in eloquent brain areas.
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Affiliation(s)
- Stefanos Voglis
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Timothy Müller
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Christiaan H B van Niftrik
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Lazar Tosic
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Marian Christoph Neidert
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Luca Regli
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
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