Intraoperative magnetic resonance: the future of surgery

Rapid, label-free identification of cerebellar structures using multiphoton microscopy

The cerebellum is the prominent laminar structure of the mammalian brain that has been implicated in various psychiatric and neurological diseases. Although clinical brain imaging techniques have provided precise anatomic images of cerebellar structures, a definitive diagnosis still requires adequate resolution to identify individual layers in cerebellar cortex, the extent of tumor, even requires the histological tissue examination during surgical procedures. In this study, multiphoton microscopy (MPM), based on second harmonic generation (SHG) and two-photon excited fluorescence (TPEF), was perform on the rat cerebellar structures and pathology with the combination of image analysis methods. Results show that MPM can reveal the cerebellar vermis, hemispheres, medulla, and ventricle, as well as axon bundles, Purkinje cells, capillaries, and the pia mater of the cerebellum. Together with custom-developed image processing algorithms, MPM could further differentiate between the gray and white matter, as well as evaluate the Purkinje cell layer, identify the cerebellar tumor boundary, and distinguish between the tumor core and peritumor regions. Our results establish a direct visualization and rapid assessment approach for the cerebellar structures, as well as suggest the feasibility of in vivo multiphoton microendoscopes and fiberscopes as clinical tools for neuropathological diagnoses.

Clinical and economic outcomes of low-field intraoperative MRI-guided tumor resection neurosurgery

PURPOSE

To compare low-field (0.15 T) intraoperative magnetic resonance imaging (iMRI)-guided tumor resection with both conventional magnetic resonance imaging (cMRI)-guided tumor resection and high-field (1.5 T) iMRI-guided resection from the clinical and economic point of view.

MATERIALS AND METHODS

We retrospectively compared 65 iMRI patients with 65 cMRI patients in terms of hospital length of stay, repeat resection rate, repeat resection interval, complication rate, cost to the patient, cost to the hospital, and cost effectiveness. In addition, we compared our low-field results with previously published high-field results.

RESULTS

The complication rate was lower for iMRI vs. cMRI in patients presenting for their initial tumor resection (45 vs. 57 complications, P = 0.048). The iMRI repeat resection interval was longer for this cohort (20.1 vs. 6.7 months, P = 0.020). iMRI was more cost-effective than cMRI for patients who had repeat resections ($10,690/RFY vs. $76,874/RFY, P < 0.001). We found no other clinical or economic differences between iMRI- and cMRI-guided tumor resection surgeries. Overall, we did not find the advantages to low-field iMRI that have been reported for high-field iMRI.

CONCLUSION

There is no adequate justification for the widespread installation of low-field iMRI in its current development state.

[Interventional MR imaging: state of the art and technological advances]

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.