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Navest RJM, Mandija S, Bruijnen T, Stemkens B, Tijssen RHN, Andreychenko A, Lagendijk JJW, van den Berg CAT. The noise navigator: a surrogate for respiratory-correlated 4D-MRI for motion characterization in radiotherapy. Phys Med Biol 2020; 65:01NT02. [PMID: 31775130 DOI: 10.1088/1361-6560/ab5c62] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Respiratory-correlated 4D-MRI can characterize respiratory-induced motion of tumors and organs-at-risk for radiotherapy treatment planning and is a necessity for image guidance of moving tumors treated on an MRI-linac. Essential for 4D-MRI generation is a robust respiratory surrogate signal. We investigated the feasibility of the noise navigator as respiratory surrogate signal for 4D-MRI generation. The noise navigator is based on the respiratory-induced modulation of the thermal noise variance measured by the receive coils during MR acquisition and thus is inherently present and synchronized with MRI data acquisition. Additionally, the noise navigator can be combined with any rectilinear readout strategy (e.g. radial and cartesian) and is independent of MR image contrast and imaging orientation. For radiotherapy applications, the noise navigator provides a robust respiratory signal for patients scanned with an elevated coil setup. This is particularly attractive for widely used cartesian sequences where currently a non-interfering self-navigation means is lacking for MRI-based simulation and MRI-guided radiotherapy. The feasibility of 4D-MRI generation with the noise navigator as respiratory surrogate signal was demonstrated for both cartesian and radial readout strategies in radiotherapy setup on four healthy volunteers and two radiotherapy patients on a dedicated 1.5 T MRI scanner and two radiotherapy patients on a 1.5 T MRI-linac system. Moreover, the respiratory-correlated 4D-MR images showed liver motion comparable to a reference 2D cine MRI series for the volunteers. For 2D cartesian cine MRI acquisitions, both the noise navigator and respiratory bellows were benchmarked against an image navigator. Respiratory phase detection based on the noise navigator agreed 1.4 times better with the image navigator than the respiratory bellows did. For a 3D Stack-of-Stars acquisitions, the noise navigator was compared to radial self-navigation and a 1.7 times higher respiratory phase detection agreement was observed than for the respiratory bellows compared to radial self-navigation.
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Affiliation(s)
- R J M Navest
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands. Computational Imaging Group for MRI Diagnostics & Therapy, Centre for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands. Author to whom any correspondence should be addressed
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Geometric inaccuracy and co-registration errors for CT, DynaCT and MRI images used in robotic stereotactic radiosurgery treatment planning. Phys Med 2020; 69:212-222. [PMID: 31918373 DOI: 10.1016/j.ejmp.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/08/2019] [Accepted: 12/04/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To measure the combined errors due to geometric inaccuracy and image co-registration on secondary images (dynamic CT angiography (dCTA), 3D DynaCT angiography (DynaCTA), and magnetic resonance images (MRI)) that are routinely used to aid in target delineation and planning for stereotactic radiosurgery (SRS). METHODS Three phantoms (one commercial and two in-house built) and two different analysis approaches (commercial and MATLAB based) were used to quantify the magnitude of geometric image distortion and co-registration errors for different imaging modalities within CyberKnife's MultiPlan treatment planning software. For each phantom, the combined errors were reported as a mean target registration error (TRE). The mean TRE's for different intramodality imaging parameters (e.g., mAs, kVp, and phantom set-ups) and for dCTA, DynaCTA, and MRI systems were measured. RESULTS Only X-ray based imaging can be performed with the commercial phantom, and the mean TRE ± standard deviation values were large compared to the in-house analysis using MATLAB. With the 3D printed phantom, even drastic changes in treatment planning CT imaging protocols did not greatly influence the mean TRE (<0.5 mm for a 1 mm slice thickness CT). For all imaging modalities, the largest mean TRE was found on DynaCT, followed by T2-weighted MR images (albeit all <1 mm). CONCLUSIONS The user may overestimate the mean TRE if the commercial phantom and MultiPlan were used solely. The 3D printed phantom design is a sensitive and suitable quality assurance tool for measuring 3D geometric inaccuracy and co-registration errors across all imaging modalities.
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Principles of Safe Stereotactic Trajectories. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Giordano M, Gallieni M, Zaed I, Samii A. Use of Frameless Stereotactic Navigation System Combined with Intraoperative Magnetic Resonance Imaging and 5-Aminolevulinic Acid. World Neurosurg 2019; 131:32-37. [PMID: 31369881 DOI: 10.1016/j.wneu.2019.07.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We have described the integrated use of a neuronavigation-guided system for frameless stereotaxy (VarioGuide [Brainlab AG, Munich, Germany]) with intraoperative magnetic resonance imaging (iMRI) and 5-aminolevulinic acid (5-ALA) and report the advantages and disadvantages that the use of these tools together can have in the treatment of various types of intracerebral lesions. METHODS After the skin incision, creation of a burr hole at the entry point, and dura opening, the VarioGuide procedure was started. Initially, the wizard software will require positioning of the stereotactic arm over the burr hole and provides feedback regarding the correct position. The procedure is performed in an iMRI theater furnished with a surgical microscope (Kinevo [Carl Zeiss AG, Oberkochen, Germany]) supplied with a violet-blue excitation light for 5-ALA fluorescence. At the end of the surgery, iMRI was performed. We present 2 exemplary cases to describe the application and workflow of these tools. RESULTS When used for traditional biopsy, the possibility of performing a new iMRI scan could be of paramount importance because the brain shift can be compensated for and an alternative trajectory can be calculated from the new images and fiber tracking reconstruction. The fluorescence of the tissue sample examined under the microscope filter can provide immediate information about the nature of the lesion, allowing for the possibility of converting the procedure to open craniotomy and tumor removal. CONCLUSION The use of combination frameless stereotaxy with iMRI and 5-ALA has shown benefits in terms of safety and precision. Moreover, the use of these tools can simplify tumor removal after simple biopsy, widening the spectrum of indications.
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Affiliation(s)
- Mario Giordano
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Massimo Gallieni
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany.
| | | | - Amir Samii
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
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Bernstock JD, Wright Z, Bag AK, Gessler F, Gillespie GY, Markert JM, Friedman GK, Johnston JM. Stereotactic Placement of Intratumoral Catheters for Continuous Infusion Delivery of Herpes Simplex Virus -1 G207 in Pediatric Malignant Supratentorial Brain Tumors. World Neurosurg 2018; 122:e1592-e1598. [PMID: 30481622 DOI: 10.1016/j.wneu.2018.11.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The engineered herpes simplex virus-1 G207, is a promising therapeutic option for central nervous system tumors. The first-ever pediatric phase 1 trial of continuous-infusion delivery of G207 via intratumoral catheters for recurrent or progressive malignant brain tumors is ongoing. In this article, we describe surgical techniques for the accurate placement of catheters in multiple supratentorial locations and perioperative complications associated with such procedures. METHODS A prospective study of G207 in children with recurrent malignant supratentorial tumors is ongoing. Preoperative stereotactic protocol magnetic resonance imaging was performed, and catheter trajectories planned using StealthStation planning software. Children underwent placement of 3-4 silastic catheters using a small incision burr hole and the Vertek system. Patients had a preinfusion computed tomography scan to confirm correct placement of catheters. RESULTS Six children underwent implantation of 3-4 catheters. Locations of catheter placement included frontal, temporal, parietal, and occipital lobes, and the insula and thalamus. There were no clinically significant perioperative complications. Postoperative computed tomography scans coupled with preoperative MRI scans demonstrated accurate placement of 21 of 22 catheters, with 1 misplaced catheter pulled back to an optimal location at the bedside. One patient had hemorrhage along the catheter tract that was clinically asymptomatic. Another patient had cerebrospinal fluid leak from a biopsy incision 9 days after surgery that was oversewn without complication. CONCLUSIONS The placement of multiple intratumoral catheters in pediatric patients with supratentorial tumors via frameless stereotactic techniques is feasible and safe. Intratumoral catheters provide a potentially effective route for the delivery of G207 and may be employed in other trials utilizing oncolytic virotherapy for brain tumors.
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Affiliation(s)
- Joshua D Bernstock
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zachary Wright
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Asim K Bag
- Department of Radiology, Neuroradiology Section, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gregory K Friedman
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - James M Johnston
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Damyanovich AZ, Rieker M, Zhang B, Bissonnette JP, Jaffray DA. Design and implementation of a 3D-MR/CT geometric image distortion phantom/analysis system for stereotactic radiosurgery. ACTA ACUST UNITED AC 2018; 63:075010. [DOI: 10.1088/1361-6560/aab33e] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Novel Use of the Leksell Gamma Frame for Stereotactic Biopsy of Posterior Fossa Lesions. World Neurosurg 2017; 107:1-5. [PMID: 28739517 DOI: 10.1016/j.wneu.2017.07.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stereotactic transcerebellar biopsies of brainstem tumors have often been reported. The Leksell frame or Cosman-Roberts-Wells frame is often used in transcerebellar approaches. However, to access lesions via the cerebellum, these frames should be secured as inferiorly on the cranium as possible, which can require exaggerated neck flexion and limit the flexible trajectory to the target. To overcome these disadvantages, we have devised a new way to use the Leksell frame for transcerebellar approaches. METHODS The frame was fixed to the upper part of the head and arc support by attaching the frame upside down, which gives surgeons a wide operative field and permits flexible trajectory planning. RESULTS Under local anesthesia, the surgery was performed in a sitting position. Air was observed in the target site on postoperative computed tomography and magnetic resonance imaging, which confirmed that a specimen had been successfully sampled from the site as planned. CONCLUSIONS Our devised transcerebellar approach provided a generous operative field and a flexible trajectory, which enabled minimally invasive biopsy of a posterior fossa lesions to be performed in a short amount of time with the patient under local anesthesia.
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Abstract
A cost-effective regularly structured three-dimensional (3D) printed grid phantom was developed to enable the quantification of machine-related magnetic resonance (MR) distortion. This phantom contains reference features, “point-like” objects, or vertices, which resulted from the intersection of mesh edges in 3D space. 3D distortions maps were computed by comparing the locations of corresponding features in both MR and computer tomography (CT) data sets using normalized cross correlation. Results are reported for six MRI scanners at both 1.5 T and 3.0 T field strengths within our institution. Mean Euclidean distance error for all MR volumes in this study, was less than 2 mm. The maximum detected error for the six scanners ranged from 2.4 mm to 6.9 mm. The conclusions in this study agree well with previous studies that indicated that MRI is quite accurate near the centre of the field but is more spatially inaccurate toward the edges of the magnetic field.
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Bradac O, Steklacova A, Nebrenska K, Vrana J, de Lacy P, Benes V. Accuracy of VarioGuide Frameless Stereotactic System Against Frame-Based Stereotaxy: Prospective, Randomized, Single-Center Study. World Neurosurg 2017; 104:831-840. [PMID: 28454992 DOI: 10.1016/j.wneu.2017.04.104] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Frameless stereotactic brain biopsy systems are widely used today. VarioGuide (VG) is a relatively novel frameless system. Its accuracy was studied in a laboratory setting but has not yet been studied in the clinical setting. The purpose of this study was to determine its accuracy and diagnostic yield and to compare this with frame-based (FB) stereotaxy. MATERIAL AND METHODS Overall, 53 patients (33 males and 20 females, 60 ± 15 years old) were enrolled into this prospective, randomized, single-center study. Twenty-six patients were randomized into the FB group and 27 patients into the VG group. Real trajectory was pointed on intraoperative magnetic resonance. The distance of the targets and angle deviation between the planned and real trajectories were computed. The overall discomfort of the patient was subjectively assessed by the visual analog scale score. RESULTS The median lesion volume was 5 mL (interquartile range [IQR]: 2-16 mL) (FB) and 16 mL (IQR: 2-27 mL) (VG), P = 0.133. The mean distance of the targets was 2.7 ± 1.1 mm (FB) and 2.9 ± 1.3 mm (VG), P = 0.456. Mean angle deviation was 2.6 ± 1.3 deg (FB) and 3.5 ± 2.1 deg (VG), P = 0.074. Diagnostic yield was 93% (25/27) in VG and 96% (25/26) in FB, P = 1.000. Mean operating time was 47 ± 26 minutes (FB) and 59 ± 31 minutes (VG), P = 0.140. One minor bleeding was encountered in the VG group. Overall patient discomfort was significantly higher in the FB group (visual analog scale score 2.5 ± 2.1 vs. 1.2 ± 0.6, P = 0,004). CONCLUSIONS The VG system proved to be comparable in terms of the trajectory accuracy, rate of complications and diagnostic yield compared with the "gold standard" represented by the traditional FB stereotaxy for patients undergoing brain biopsy. VG is also better accepted by patients.
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Affiliation(s)
- Ondrej Bradac
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic.
| | - Anna Steklacova
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
| | - Katerina Nebrenska
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
| | - Jiri Vrana
- Department of Neuroradiology, Military University Hospital, Prague, The Czech Republic
| | - Patricia de Lacy
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
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Park SC, Lee CS, Kim SM, Choi EJ, Lee JK. Comparison of the Stereotactic Accuracies of Function-Guided Deep Brain Stimulation, Calculated Using Multitrack Target Locations Geometrically Inferred from Three-Dimensional Trajectory Rotations, and of Magnetic Resonance Imaging-Guided Deep Brain Stimulation and Outcomes. World Neurosurg 2017; 98:734-749.e7. [DOI: 10.1016/j.wneu.2016.11.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
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Weygand J, Fuller CD, Ibbott GS, Mohamed ASR, Ding Y, Yang J, Hwang KP, Wang J. Spatial Precision in Magnetic Resonance Imaging-Guided Radiation Therapy: The Role of Geometric Distortion. Int J Radiat Oncol Biol Phys 2016; 95:1304-16. [PMID: 27354136 DOI: 10.1016/j.ijrobp.2016.02.059] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/05/2016] [Accepted: 02/25/2016] [Indexed: 12/11/2022]
Abstract
Because magnetic resonance imaging-guided radiation therapy (MRIgRT) offers exquisite soft tissue contrast and the ability to image tissues in arbitrary planes, the interest in this technology has increased dramatically in recent years. However, intrinsic geometric distortion stemming from both the system hardware and the magnetic properties of the patient affects MR images and compromises the spatial integrity of MRI-based radiation treatment planning, given that for real-time MRIgRT, precision within 2 mm is desired. In this article, we discuss the causes of geometric distortion, describe some well-known distortion correction algorithms, and review geometric distortion measurements from 12 studies, while taking into account relevant imaging parameters. Eleven of the studies reported phantom measurements quantifying system-dependent geometric distortion, while 2 studies reported simulation data quantifying magnetic susceptibility-induced geometric distortion. Of the 11 studies investigating system-dependent geometric distortion, 5 reported maximum measurements less than 2 mm. The simulation studies demonstrated that magnetic susceptibility-induced distortion is typically smaller than system-dependent distortion but still nonnegligible, with maximum distortion ranging from 2.1 to 2.6 mm at a field strength of 1.5 T. As expected, anatomic landmarks containing interfaces between air and soft tissue had the largest distortions. The evidence indicates that geometric distortion reduces the spatial integrity of MRI-based radiation treatment planning and likely diminishes the efficacy of MRIgRT. Better phantom measurement techniques and more effective distortion correction algorithms are needed to achieve the desired spatial precision.
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Affiliation(s)
- Joseph Weygand
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas.
| | - Clifton David Fuller
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Geoffrey S Ibbott
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology and Nuclear Medicine, Alexandria University, Alexandria, Egypt
| | - Yao Ding
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas
| | - Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas
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12
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Godenschweger F, Kägebein U, Stucht D, Yarach U, Sciarra A, Yakupov R, Lüsebrink F, Schulze P, Speck O. Motion correction in MRI of the brain. Phys Med Biol 2016; 61:R32-56. [PMID: 26864183 DOI: 10.1088/0031-9155/61/5/r32] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Subject motion in MRI is a relevant problem in the daily clinical routine as well as in scientific studies. Since the beginning of clinical use of MRI, many research groups have developed methods to suppress or correct motion artefacts. This review focuses on rigid body motion correction of head and brain MRI and its application in diagnosis and research. It explains the sources and types of motion and related artefacts, classifies and describes existing techniques for motion detection, compensation and correction and lists established and experimental approaches. Retrospective motion correction modifies the MR image data during the reconstruction, while prospective motion correction performs an adaptive update of the data acquisition. Differences, benefits and drawbacks of different motion correction methods are discussed.
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Affiliation(s)
- F Godenschweger
- Biomedical Magnetic Resonance, Otto-von-Guericke University, Magdeburg, Germany
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Manjila S, Knudson KE, Johnson C, Sloan AE. Monteris AXiiiS Stereotactic Miniframe for Intracranial Biopsy: Precision, Feasibility, and Ease of Use. Oper Neurosurg (Hagerstown) 2015; 12:119-127. [PMID: 29506090 DOI: 10.1227/neu.0000000000001124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stereotactic biopsy is an important and minimally invasive technique used for a variety of indications in neurosurgery. Initially, this technique required a frame, but recently there have been a number of newer, less cumbersome approaches to biopsy including robotic arms, fixed arms, and, more recently, skull-mounted miniframes. Miniframes are attractive because they are disposable and low profile. However, the relatively limited degree of freedom offered by currently available devices necessitates a preplanned burr hole, which in turn limits flexibility and multiple trajectories. The AXiiiS device is a skull-mounted, magnetic resonance imaging-compatible miniframe that provides a similar degree of freedom with a frame while maintaining a low-profile, disposable platform. OBJECTIVE To assess the image-guided trajectory alignment accuracy using AXiiiS stereotactic miniframe biopsy of intracranial lesions. The accuracy of the AXiiiS device is compared with the Navigus Trajectory Guide as platforms. METHODS After approval by our institutional review board, medical records of 10 neurosurgical patients with intracranial pathologies were chosen for AXiiiS stereotactic miniframe biopsy, and histological correlation was obtained. RESULTS Ten reported cases demonstrate the precision and ease of using the AXiiiS stereotactic miniframe for biopsy of intracranial lesions in conjunction with preoperative magnetic resonance imaging. Multiple trajectories and angles have been used with precision and safety. CONCLUSION The AXiiiS stereotactic miniframe is a feasible, safe, and disposable platform for multitrajectory intracranial biopsies. Compared with existing platforms, this novel device provides a more stable base and wider limits of trajectory angles with comparable accuracy and precision.
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Affiliation(s)
- Sunil Manjila
- Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, University Hospitals Case Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Kathleen E Knudson
- Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, University Hospitals Case Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Carleton Johnson
- Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, University Hospitals Case Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Andrew E Sloan
- Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, University Hospitals Case Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
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Wangerid T, Benmakhlouf H, Grane P, Bartek J, Svensson M, Förander P. Implication of using MRI co-registered with CT in Leksell Gamma Knife® dose planning for patients with vestibular schwannoma. Clin Neurol Neurosurg 2015; 138:10-5. [DOI: 10.1016/j.clineuro.2015.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/10/2015] [Accepted: 07/11/2015] [Indexed: 10/23/2022]
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15
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Yarach U, Luengviriya C, Danishad A, Stucht D, Godenschweger F, Schulze P, Speck O. Correction of gradient nonlinearity artifacts in prospective motion correction for 7T MRI. Magn Reson Med 2014; 73:1562-9. [PMID: 24798889 DOI: 10.1002/mrm.25283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/07/2014] [Accepted: 04/15/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE To demonstrate the effect of gradient nonlinearity and develop a method for correction of gradient nonlinearity artifacts in prospective motion correction (Mo-Co). METHODS Nonlinear gradients can induce geometric distortions in magnetic resonance imaging, leading to pixel shifts with errors of up to several millimeters, thereby interfering with precise localization of anatomical structures. Prospective Mo-Co has been extended by conventional gradient warp correction applied to individual phase encoding steps/groups during the reconstruction. The gradient-related displacements are approximated using spherical harmonic functions. In addition, the combination of this method with a retrospective correction of the changes in the coil sensitivity profiles relative to the object (augmented sensitivity encoding (SENSE) reconstruction) was evaluated in simulation and experimental data. RESULTS Prospective Mo-Co under gradient fields and coils sensitivity inconsistencies results in residual blurring, spatial distortion, and coil sensitivity mismatch artifacts. These errors can be considerably mitigated by the proposed method. High image quality with very little remaining artifacts was achieved after a few iterations. The relative image errors decreased from 25.7% to below 17.3% after 10 iterations. CONCLUSION The combined correction of gradient nonlinearity and sensitivity map variation leads to a pronounced reduction of residual motion artifacts in prospectively motion-corrected data.
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Affiliation(s)
- Uten Yarach
- Department of Biomedical Magnetic Resonance, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; Department of Radiological Technology, Chiangmai University, Chiang Mai, Thailand
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Lefranc M, Derrey S, Merle P, Tir M, Constans JM, Montpellier D, Macron JM, Le Gars D, Peltier J, Baledentt O, Krystkowiak P. High-Resolution 3-Dimensional T2*-Weighted Angiography (HR 3-D SWAN). Neurosurgery 2014; 74:615-26; discussion 627. [DOI: 10.1227/neu.0000000000000319] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
BACKGROUND:
Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for Parkinson's disease.
OBJECTIVE:
To characterize an optimized magnetic resonance imaging (MRI) sequence (high-resolution 3-dimensional T2*-weighted angiography [HR 3-D SWAN]) for direct STN targeting.
METHODS:
Sequence distortions were measured using the Leksell stereotactic phantom. Eight consecutive candidates for STN-DBS underwent HR 3-D SWAN MRI for direct identification of the 16 STN. Two senior neurosurgeons independently determined the boundaries of STN on a semiquantitative scale (ranging from 1 [identification very easy] to 4 [identification very difficult]) and the anatomic target within the nucleus. The anatomic data were compared with electrophysiological recordings (48 microrecordings). We examined the anatomic location of the active contacts on MRI.
RESULTS:
The mean distortion error over the phantom was 0.16 mm. For the 16 STNs, identification of the upper, internal, anterior, and external edges was considered to be easy (scores of 1 or 2). The distinction between the substantia nigra and the STN was rated 1 or 2 for all but 6 nuclei. In the mediolateral axis, electrophysiological recordings covered perfectly anatomic data. In the craniocaudal axis, the mean differences between the electrophysiological data and the anatomic data were 0.8 mm and 0.19 mm for the “entry” and “exit” of the STN, respectively. All active contacts were located within the STN on MRI.
CONCLUSION:
HR 3-D SWAN allows easy visualization of the STN. Adapted to stereotactic requirement, the sequence simplifies direct targeting in STN-DBS surgery.
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Affiliation(s)
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Medical Center, Rouen, France
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Lefranc M, Capel C, Pruvot AS, Fichten A, Desenclos C, Toussaint P, Le Gars D, Peltier J. The Impact of the Reference Imaging Modality, Registration Method and Intraoperative Flat-Panel Computed Tomography on the Accuracy of the ROSA® Stereotactic Robot. Stereotact Funct Neurosurg 2014; 92:242-50. [DOI: 10.1159/000362936] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/13/2014] [Indexed: 11/19/2022]
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Targeting the subthalamic nucleus for deep brain stimulation--a comparative study between magnetic resonance images alone and fusion with computed tomographic images. World Neurosurg 2011; 75:132-7; discussion 22-4, 29-31. [PMID: 21492677 DOI: 10.1016/j.wneu.2010.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 09/13/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study is to determine whether stereotactic computed tomographic (CT) images fused with magnetic resonance images (MRI) is superior to stereotactic MRI alone in accuracy for targeting the subthalamic nucleus (STN) in deep brain stimulation (DBS). METHODS During 2006 to 2007, 21 consecutive patients with Parkinson's disease were enrolled in this retrospective cohort study. CT Fusion group included 10 patients who underwent 20 procedures of STN-DBS under MRI-directed targeting in which the MRIs were fused to stereotactic CT images for surgical coordinates. MRI group included 11 patients who underwent 20 procedures under MRI-directed targeting alone. RESULTS After DBS surgery, in comparison to baseline levodopa (L-dopa) OFF, Unified Parkinson Disease Rating Scale, Part III scores improved by 43.6% ± 20.3% and 39.0% ± 15.6% (P = 0.60) in CT Fusion group and MRI group, respectively (L-dopa OFF/DBS ON). The mean decrease in L-dopa equivalent daily dose was 38.9% ± 26.3% and 36.7% ± 30.5% (P = 0.87), respectively. Single microelectrode recording (MER) trajectory procedure was experienced in 65% of patients in the CT Fusion group (13/20) and 45% of patients in the MRI group (9/20). The mean recorded STN length from initial to final MER trajectory in the CT Fusion and MRI groups was 4.3 mm (standard deviation [SD] = 1.8 mm)/5.1 mm (SD = 0.5 mm) and 3.6 mm (SD = 1.7 mm) (P = 0.214)/4.5 mm (SD = 0.7 mm) (P = 0.006), respectively. The final recorded STN length was significantly longer in the CT Fusion group. CONCLUSIONS In-frame-based stereotactic STN targeting, an image fusion technique between stereotactic CT and MRI, can record a significantly longer STN length through limited MER compared with MRI alone. Whether this could translate into better clinical outcome and less morbidity still need a large and randomized trial.
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Abstract
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.
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Pollock BE, Link MJ, Foote RL. Failure rate of contemporary low-dose radiosurgical technique for vestibular schwannoma Clinical article. J Neurosurg 2009; 111:840-4. [DOI: 10.3171/2009.3.jns08949] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The decline in cranial nerve morbidity after radiosurgery for vestibular schwannoma (VS) correlates with dose reduction and other technical changes to this procedure. The effect these changes have had on tumor control has not been well documented.
Methods
The authors performed a retrospective review of 293 patients with VSs who underwent radiosurgery between 1990 and 2004 and had a minimum of 24 months of imaging follow-up (90% of the entire series). The median radiation dose to the tumor margin was 13 Gy. Treatment failure was defined as progressive tumor enlargement noted on 2 or more imaging studies. The mean postradiosurgical follow-up was 60.9 ± 32.5 months.
Results
Tumor growth was noted in 15 patients (5%) at a median of 32 months after radiosurgery. Radiographically demonstrated tumor control was 96% at 3 years and 94% at 7 years after radiosurgery. Univariate analysis revealed 2 factors that correlated with failed radiosurgery for VS: an increasing number of isocenters (p = 0.03) and tumor margin radiation doses ≤ 13 Gy (p = 0.02). Multivariate analysis showed that only an increasing number of isocenters correlated with failed VS radiosurgery (hazard ratio 1.1, 95% CI 1.02–1.32, p < 0.05). The tumor margin radiation dose (p = 0.22) was not associated with tumor growth after radiosurgery.
Conclusions
Distortion of stereotactic MR imaging coupled with increased radiosurgical conformality and progressive dose reduction likely caused some VSs to receive less than the prescribed radiation dose to the entire tumor volume.
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Affiliation(s)
- Bruce E. Pollock
- 1Departments of Neurological Surgery and
- 2Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Robert L. Foote
- 2Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Ringel F, Ingerl D, Ott S, Meyer B. VARIOGUIDE: A NEW FRAMELESS IMAGE‐GUIDED STEREOTACTIC SYSTEM—ACCURACY STUDY AND CLINICAL ASSESSMENT. Oper Neurosurg (Hagerstown) 2009; 64:365-71; discussion 371-3. [DOI: 10.1227/01.neu.0000341532.15867.1c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
VarioGuide (BrainLAB AG, Feldkirchen, Germany) is a new system for frameless image-guided stereotaxy. In the present study, we aimed to assess target point accuracy in a laboratory setting and the clinical feasibility of the system.
METHODS
Using the phantom of our frame-based stereotactic system (Riechert-Mundinger; Inomed Medizintechnik GmbH, Teningen, Germany), target points were approached from different angles with the frameless system. Target point deviation in the x, y, and z planes was assessed. Furthermore, patients harboring intracranial lesions were diagnostically biopsied using VarioGuide.
RESULTS
Phantom-based accuracy measurements yielded a mean target point deviation of 0.7 mm. Between February 2007 and April 2008, 27 patients were diagnostically biopsied. Lesion volumes ranged from 0.2 to 117.6 cm3, trajectory length ranged from 25.3 to 64.1 mm, and the diagnostic yield was 93%.
CONCLUSION
Concluding from the phantom measurements with ideal image-object registration, assumed spherical lesions with a volume of 0.524 cm3 can be biopsied with 100% target localization. Early clinical data revealed VarioGuide to be safe and accurate for lesions of 0.2 cm3 and larger. Thereby, the system seems feasible for the biopsy of most intracranial lesions.
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Affiliation(s)
- Florian Ringel
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Dominik Ingerl
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Stephanie Ott
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
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Rosenfeld JV. Surgical alleviation of Parkinson's disease. J Clin Neurosci 2008; 5:1-4. [PMID: 18644278 DOI: 10.1016/s0967-5868(98)90192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J V Rosenfeld
- Department of Neurosurgery, The Royal Melbourne Hospital and Department of Surgery, University of Melbourne, Parkville, Victoria 3050, Australia
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Mori Y, Hayashi N, Iwase M, Yamada M, Takikawa Y, Uchiyama Y, Oda K, Kaii O. Stereotactic imaging for radiosurgery: localization accuracy of magnetic resonance imaging and positron emission tomography compared with computed tomography. Stereotact Funct Neurosurg 2006; 84:142-6. [PMID: 16899978 DOI: 10.1159/000094846] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) provide complementary information for treatment planning in stereotactic radiosurgery. We evaluated the localization accuracy of MRI and PET compared with CT. Two kinds of phantoms applicable to the Leksell G stereotactic skull frame (Elekta, Tokyo) were developed. Deviations of measured coordinates at target points (x = 50, 100, 150; y = 50, 100, 150) were determined on different axial planes (z = 30-140 for MRI and CT study and Z = 50-120 for PET and CT study). For MRI, the deviations were no more than 0.8 mm in each direction. For PET, the deviations were no more than 2.7 mm. For both imaging modalities studied, accuracy was at or below the imaging resolution (pixel size) and should be considered useful for clinical stereotactic planning purposes.
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Affiliation(s)
- Yoshimasa Mori
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Japan.
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Pollock BE, Stafford SL. Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 2005; 62:1427-31. [PMID: 16029803 DOI: 10.1016/j.ijrobp.2004.12.067] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Revised: 12/27/2004] [Accepted: 12/28/2004] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the efficacy and safety of stereotactic radiosurgery as primary management for patients with imaging defined cavernous sinus meningiomas. METHODS Between 1992 and 2001, 49 patients had radiosurgery for dural-based masses of the cavernous sinus presumed to be meningiomas. The mean patient age was 55.5 years. The mean tumor volume was 10.2 mL; the mean tumor margin dose was 15.9 Gy. The mean follow-up was 58 months (range, 16-144 months). RESULTS No tumor enlarged after radiosurgery. Twelve of 38 patients (26%) with preexisting diplopia or facial numbness/pain had improvement in cranial nerve function. Five patients (10%) had new (n = 3) or worsened (n = 2) trigeminal dysfunction; 2 of these patients (4%) underwent surgery at 20 and 25 months after radiosurgery despite no evidence of tumor progression. Neither patient improved after partial tumor resection. One patient (2%) developed an oculomotor nerve injury. One patient (2%) had an ischemic stroke related to occlusion of the cavernous segment of the internal carotid artery. Event-free survival was 98%, 85%, and 80% at 1, 3, and 7 years after radiosurgery, respectively. Univariate analysis of patient and dosimetric factors found no analyzed factor correlated with postradiosurgical morbidity. CONCLUSIONS Radiosurgery was an effective primary management strategy for patients with an imaging defined cavernous sinus meningioma. Except in situations of symptomatic mass effect, unusual clinical presentation, or atypical imaging features, surgery to confirm the histologic diagnosis is unlikely to provide clinical benefit.
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Affiliation(s)
- Bruce E Pollock
- Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Menuel C, Garnero L, Bardinet E, Poupon F, Phalippou D, Dormont D. Characterization and correction of distortions in stereotactic magnetic resonance imaging for bilateral subthalamic stimulation in Parkinson disease. J Neurosurg 2005; 103:256-66. [PMID: 16175855 DOI: 10.3171/jns.2005.103.2.0256] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. High-frequency stimulation of the subthalamic nucleus (STN) is effective for treating refractory idiopathic Parkinson disease (PD). In stereotactic conditions magnetic resonance (MR) imaging is used by many teams to perform preoperative targeting of the STN. The goal of this study was to analyze and correct the geometrically observed MR imaging acquisitions used for targeting of the STN.
Methods. A dedicated phantom of known geometry was used. The authors calculated existing shifts between measured points and theoretically defined points on the same T1- and T2-weighted sequences used to target the STN. A shifting volume was built to correct the phantom images and images acquired preoperatively in 13 patients with PD. A quantitative study of the correction was conducted using the phantom images and acquisitions acquired in these patients. To quantify the distortion corrections, the authors segmented the lateral ventricles and calculated the overlap of the corrected and uncorrected values between T1 and T2 segmentation.
The authors found that the distortions were greater in the direction of slice selection and frequency encoding and weaker on three-dimensional T1-weighted acquisitions. On T2-weighted acquisitions, the maximum shifts were 2.19 mm in the frequency-encoding direction and 3.81 mm in slice selection. The geometrical distortion was significantly reduced and smaller than pixel size after distortion correction. Assessment of the patients' scans showed that the mean ventricular overlap was 76% before and 94% after correction.
Conclusions. The authors found that significant distortions can be observed on T2-weighted images used to demonstrate the STN. These distortions can be corrected using appropriate software.
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Affiliation(s)
- Carole Menuel
- Laboratoire de Neurosciences Cognitives et Imagerie Cérébrale, Groupe Hospitalier Pitié Salpêtrière, Paris, France.
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Doran SJ, Charles-Edwards L, Reinsberg SA, Leach MO. A complete distortion correction for MR images: I. Gradient warp correction. Phys Med Biol 2005; 50:1343-61. [PMID: 15798328 DOI: 10.1088/0031-9155/50/7/001] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
MR images are known to be distorted because of both gradient nonlinearity and imperfections in the B0 field, the latter caused either by an imperfect shim or sample-induced distortions. This paper describes in detail a method for correcting the gradient warp distortion, based on a direct field mapping using a custom-built phantom with three orthogonal grids of fluid-filled rods. The key advance of the current work over previous contributions is the large volume of the mapping phantom and the large distortions (>25 mm) corrected, making the method suitable for use with large field of view, extra-cranial images. Experimental measurements on the Siemens AS25 gradient set, as installed on a Siemens Vision scanner, are compared with a theoretical description of the gradient set, based on the manufacturer's spherical harmonic coefficients. It was found that over a volume of 320x200x340 mm3 distortions can be successfully mapped to within the voxel resolution of the raw imaging data, whilst outside this volume, correction is still good but some systematic errors are present. The phenomenon of through-plane distortion (also known as 'slice warp') is examined in detail, and the perturbation it causes to the measurements is quantified and corrected. At the very edges of the region of support provided by the phantom, through-plane distortion is extreme and only partially corrected by the present method. Solutions to this problem are discussed. Both phantom and patient data demonstrate the efficacy of the gradient warp correction.
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Affiliation(s)
- Simon J Doran
- Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
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28
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Wang D, Doddrell DM. A proposed scheme for comprehensive characterization of the measured geometric distortion in magnetic resonance imaging using a three-dimensional phantom. Med Phys 2005; 31:2212-8. [PMID: 15377086 DOI: 10.1118/1.1767051] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Recently, a 3-dimensional phantom that can provide a comprehensive, accurate and complete measurement of the geometric distortion in MRI has been developed. In this paper, a scheme for characterizing the measured geometric distortion using the 3-D phantom is described. In the proposed scheme, a number of quantitative measures are developed and used to characterize the geometric distortion. These measures encompass the overall and spatial aspects of the geometric distortion. Two specific types of volume of interest, rectangular parallelepipeds (including cubes) and spheres are considered in the proposed scheme. As an illustration, characterization of the geometric distortion in a Siemens 1.5T Sonata MRI system using the proposed scheme is presented. As shown, the proposed scheme provides a comprehensive assessment of the geometric distortion. The scheme can be potentially used as a standard procedure for the assessment of geometric distortion in MRI.
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Affiliation(s)
- Deming Wang
- Centre for Magnetic Resonance, The University of Queensland, Brisbane 4072, Australia.
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Simon SL, Douglas P, Baltuch GH, Jaggi JL. Error Analysis of MRI and Leksell Stereotactic Frame Target Localization in Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2005; 83:1-5. [PMID: 15695925 DOI: 10.1159/000083861] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stereotactic deep brain stimulation (DBS) is the surgical treatment of choice for medication-refractory patients with Parkinson's disease and essential tremor. The subthalamic nucleus and ventral intermediate nucleus of the thalamus appear to be effective targets for electrode placement. Because these targets are small and encased in fiber tracts, their localization can be exceedingly difficult. However, the precision of electrode placement is crucial for obtaining successful results. Currently, surgeons rely on preoperative MRI or CT images to derive stereotactic coordinates for targeting sites such as the subthalamic nucleus and ventral intermediate nucleus of the thalamus coupled with microelectrode recordings during surgery for proper electrode placement. However, it has been argued that the stereotactic head frame produces detrimental artifacts during MRI. We examined MRI images taken from 11 patients undergoing repeat DBS surgery, and determined the coordinates of the previously placed electrode. We then set the Leksell G stereotactic frame to these coordinates and obtained fluoroscope-localizing images. Using MATLAB image analysis tools, we were able to quantify the 3-dimensional error in target localization by measuring the distance from the electrode tip to the targeted coordinate. The mean errors were 0.09 +/- 0.34 mm perpendicular, lateral to medial, 0.01 +/- 0.32 perpendicular, posterior to anterior, and -0.08 +/- 0.33 mm parallel to the electrode, superior to inferior. According to statistical analysis, the error was random and did not seem to move in any predictable fashion. Therefore, we conclude that preoperative MRI images can be safely used in DBS surgery, and they do not negatively affect its accuracy.
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Affiliation(s)
- Scott L Simon
- Parkinson's Disease and Movement Disorders Center at Pennsylvania Hospital, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19107, USA
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Wang D, Doddrell DM, Cowin G. A novel phantom and method for comprehensive 3-dimensional measurement and correction of geometric distortion in magnetic resonance imaging. Magn Reson Imaging 2004; 22:529-42. [PMID: 15120173 DOI: 10.1016/j.mri.2004.01.008] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2003] [Accepted: 01/23/2004] [Indexed: 11/30/2022]
Abstract
A phantom that can be used for mapping geometric distortion in magnetic resonance imaging (MRI) is described. This phantom provides an array of densely distributed control points in three-dimensional (3D) space. These points form the basis of a comprehensive measurement method to correct for geometric distortion in MR images arising principally from gradient field non-linearity and magnet field inhomogeneity. The phantom was designed based on the concept that a point in space can be defined using three orthogonal planes. This novel design approach allows for as many control points as desired. Employing this novel design, a highly accurate method has been developed that enables the positions of the control points to be measured to sub-voxel accuracy. The phantom described in this paper was constructed to fit into a body coil of a MRI scanner, (external dimensions of the phantom were: 310 mm x 310 mm x 310 mm), and it contained 10,830 control points. With this phantom, the mean errors in the measured coordinates of the control points were on the order of 0.1 mm or less, which were less than one tenth of the voxel's dimensions of the phantom image. The calculated three-dimensional distortion map, i.e., the differences between the image positions and true positions of the control points, can then be used to compensate for geometric distortion for a full image restoration. It is anticipated that this novel method will have an impact on the applicability of MRI in both clinical and research settings, especially in areas where geometric accuracy is highly required, such as in MR neuro-imaging.
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Affiliation(s)
- Deming Wang
- Centre for Magnetic Resonance, The University of Queensland, Brisbane 4072, Australia.
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31
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Borden JA, Tsai JS, Mahajan A. Effect of subpixel magnetic resonance imaging shifts on radiosurgical dosimetry for vestibular schwannoma. J Neurosurg 2002. [DOI: 10.3171/jns.2002.97.supplement_5.0445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Saint-Cyr JA, Hoque T, Pereira LCM, Dostrovsky JO, Hutchison WD, Mikulis DJ, Abosch A, Sime E, Lang AE, Lozano AM. Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging. J Neurosurg 2002; 97:1152-66. [PMID: 12450038 DOI: 10.3171/jns.2002.97.5.1152] [Citation(s) in RCA: 203] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors sought to determine the location of deep brain stimulation (DBS) electrodes that were most effective in treating Parkinson disease (PD). METHODS Fifty-four DBS electrodes were localized in and adjacent to the subthalamic nucleus (STN) postoperatively by using magnetic resonance (MR) imaging in a series of 29 patients in whom electrodes were implanted for the treatment of medically refractory PD, and for whom quantitative clinical assessments were available both pre- and postoperatively. A novel MR imaging sequence was developed that optimized visualization of the STN. The coordinates of the tips of these electrodes were calculated three dimensionally and the results were normalized and corrected for individual differences by using intraoperative neurophysiological data (mean 5.13 mm caudal to the midcommissural point [MCP], 8.46 mm inferior to the anterior commissure-posterior commissure [AC-PC], and 10.2 mm lateral to the midline). Despite reported concerns about distortion on the MR image, reconstructions provided consistent data for the localization of electrodes. The neurosurgical procedures used, which were guided by combined neuroimaging and neurophysiological methods, resulted in the consistent placement of DBS electrodes in the subthalamus and mesencephalon such that the electrode contacts passed through the STN and dorsally adjacent fields of Forel (FF) and zona incerta (ZI). The mean location of the clinically effective contacts was in the anterodorsal STN (mean 1.62 mm posterior to the MCP, 2.47 mm inferior to the AC-PC, and 11.72 mm lateral to the midline). Clinically effective stimulation was most commonly directed at the anterodorsal STN, with the current spreading into the dorsally adjacent FF and ZI. CONCLUSIONS The anatomical localization of clinically effective electrode contacts provided in this study yields useful information for the postoperative programming of DBS electrodes.
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Affiliation(s)
- Jean A Saint-Cyr
- Department of Surgery, Division of Neurosurgery, University of Toronto and University Health Network, Toronto, Ontario, Canada.
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Ryken TC, Haller JW. Modification of reference array attachment for image guided neurosurgery: direct cranial fixation. Technol Cancer Res Treat 2002; 1:401-4. [PMID: 12625766 DOI: 10.1177/153303460200100511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We have modified the cranial fixation technique of the reference array used for the Stealth (Medtronics Inc., Minneapolis, MN) image guided neurosurgical workstation to avoid rigid immobilization and to accommodate patients undergoing awake procedures. The modification allows attachment of a reference array directly to the skull prior to registration, avoiding the requirement for rigid cranial fixation. The accuracy of fiducial registration for the modified reference array was compared to the conventional reference array using a phantom system yielding similar registration results and target accuracy. The successful application of the modified system to two operative cases is described.
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Affiliation(s)
- Timothy C Ryken
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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Onizuka M, Tokunaga Y, Shibayama A, Miyazaki H. Computer-assisted neurosurgical navigational system for transsphenoidal surgery--technical note. Neurol Med Chir (Tokyo) 2001; 41:565-8; discussion 569. [PMID: 11758712 DOI: 10.2176/nmc.41.565] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transsphenoidal surgery carries the risk of carotid artery injury even for very experienced neurosurgeons. The computer-assisted neurosurgical (CANS) navigational system was used to obtain more precise guidance, based on the axial and coronal images during the transsphenoidal approach for nine pituitary adenomas. The CANS navigator consists of a three-dimensional digitizer, a computer, and a graphic unit, which utilizes electromagnetic coupling technology to detect the spatial position of a suction tube attached to a magnetic sensor. Preoperatively, the magnetic resonance images are transferred and stored in the computer and the tip of the suction tube is shown on a real-time basis superimposed on the preoperative images. The CANS navigation system correctly displayed the surgical orientation and provided localization in all nine patients. No intraoperative complications were associated with the use of this system. However, outflow of cerebrospinal fluid during tumor removal may affect the accuracy, so the position of the probe when the tumor is removed must be accurately determined. The CANS navigator enables precise localization of the suction tube during the transsphenoidal approach and allows safer and less-invasive surgery.
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Affiliation(s)
- M Onizuka
- Department of Neurosurgery, Miyazaki Hospital, Isahaya, Nagasaki, Japan.
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35
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Patwardhan AJ, Eliez S, Warsofsky IS, Glover GH, White CD, Giedd JN, Peterson BS, Rojas DC, Reiss AL. Effects of image orientation on the comparability of pediatric brain volumes using three-dimensional MR data. J Comput Assist Tomogr 2001; 25:452-7. [PMID: 11351198 DOI: 10.1097/00004728-200105000-00020] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to examine the comparability of morphometric measurements made on pediatric data sets collected at five scanner locations, each using variations on a 3D spoiled gradient-recalled echo (SPGR) pulse sequence. METHOD Archived MR data from 60 typically developing children were collected and separated into seven groups based on the pulse sequence used. A highly automated image-processing procedure was used to segment the brain data into white tissue, gray tissue, and CSF compartments and into various neuroanatomic regions of interest. RESULTS Volumetric comparisons between groups revealed differences in areas of the temporal and occipital lobes. These differences were observed when comparing data sets with different image orientations and appeared to be due to partial volume averaging (PVA) and susceptibility-induced geometric distortions. CONCLUSION Our results indicate that slice selection and image resolution should be controlled in volumetric studies using aggregated data from multiple centers to minimize the effects of PVA and susceptibility-induced geometric distortions.
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Affiliation(s)
- A J Patwardhan
- Stanford Psychiatry Neuroimaging Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5719, USA
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36
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Yu C, Apuzzo ML, Zee CS, Petrovich Z. A Phantom Study of the Geometric Accuracy of Computed Tomographic and Magnetic Resonance Imaging Stereotactic Localization with the Leksell Stereotactic System. Neurosurgery 2001. [DOI: 10.1227/00006123-200105000-00025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Yu C, Apuzzo ML, Zee CS, Petrovich Z. A phantom study of the geometric accuracy of computed tomographic and magnetic resonance imaging stereotactic localization with the Leksell stereotactic system. Neurosurgery 2001; 48:1092-8; discussion 1098-9. [PMID: 11334276 DOI: 10.1097/00006123-200105000-00025] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the spatial accuracy of magnetic resonance imaging (MRI) and computed tomographic stereotactic localization with the Leksell stereotactic system. METHODS The phantom was constructed in the shape of a box, 164 mm in each dimension, with three perpendicular arrays of solid acrylic rod, 5 mm in diameter and spaced 30 mm apart within the phantom. In this study, images from two different MRI scanners and a computed tomographic scanner were obtained using the same Leksell (Elekta Instruments, Stockholm, Sweden) head frame placement. The coordinates of the rod images in the three principal planes were measured by using a tool provided with Leksell GammaPlan software (Elekta Instruments, Norcross, GA) and were compared with the physical phantom measurements. RESULTS The greatest distortion was found around the periphery, and the least distortion (<1.5 mm) was present in the middle and most other areas of the phantom. In the phantom study using computed tomography, the mean values of the maximum errors for the x, y, and z axes were 1.0 mm (range, 0.2-1.3 mm), 0.4 mm (range, 0.1-0.8 mm), and 3.8 mm (range, 1.9-5.1 mm), respectively. The mean values of the maximum errors when using the Philips MRI scanner (Philips Medical Systems, Shelton, CT) were 0.9 mm (range, 0.4-1.7 mm), 0.2 mm (range, 0.0-0.7 mm), and 1.9 mm (range, 1.3-2.3 mm), respectively. Using the Siemens MRI scanner (Siemens Medical Systems, New York, NY), these values were 0.4 mm (range, 0.0-0.7 mm), 0.6 mm (range, 0.0-1.0 mm), and 1.6 mm (range, 0.8-2.0 mm), respectively. The geometric accuracy of the MRI scans when using the Siemens scanner was greatly improved after the implementation of a new software patch provided by the manufacturer. The accuracy also varied with the direction of phase encoding. CONCLUSION The accuracy of target localization for most intracranial lesions during stereotactic radiosurgery can be achieved within the size of a voxel, especially by using the Siemens MRI scanner at current specifications and with a new software patch. However, caution is warranted when imaging peripheral lesions, where the distortion is greatest.
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Affiliation(s)
- C Yu
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
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38
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Berks G, Ghassemi A, von Keyserlingk DG. Spatial registration of digital brain atlases based on fuzzy set theory. Comput Med Imaging Graph 2001; 25:1-10. [PMID: 11120403 DOI: 10.1016/s0895-6111(00)00038-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We present a semiautomatic method based on fuzzy set theory for adjusting a computerized brain atlas to magnetic resonance images (MRIs) of the human cerebral cortex. The atlas was registered to three-dimensional MRI data sets of 10 healthy volunteers. After a global matching using the external contour of the brain, several local procedures were performed regarding selected primary furrows and cytoarchitectonic areas. The final transformation matrix was calculated with respect to these anatomical structures and to their local matrices. Evaluation revealed an increase in accuracy as expressed by a reduction of the visible mismatch with respect to the registration of cortical and subcortical brain structures.
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Affiliation(s)
- G Berks
- Department of Anatomy I, University of Technology (RWTH), Pauwelsstrasse 30, D-52057, Aachen, Germany.
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39
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Yu C, Petrovich Z, Apuzzo MLJ, Luxton G. An image fusion study of the geometric accuracy of magnetic resonance imaging with the Leksell stereotactic localization system. J Appl Clin Med Phys 2001; 2:42-50. [PMID: 11674837 PMCID: PMC5726018 DOI: 10.1120/jacmp.v2i1.2627] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2000] [Accepted: 10/04/2000] [Indexed: 11/23/2022] Open
Abstract
A special acrylic phantom designed for both magnetic resonance imaging (MRI) and computed tomography (CT) was used to assess the geometric accuracy of MRI-based stereotactic localization with the Leksell stereotactic head frame and localizer system. The acrylic phantom was constructed in the shape of a cube, 164 mm in each dimension, with three perpendicular arrays of solid acrylic rods, 5 mm in diameter and spaced 30 mm apart within the phantom. Images from two MR scanners and a CT scanner were obtained with the same Leksell head frame placement. Using image fusion provided by the Leksell GammaPlan (LGP) software, the coordinates of the intraphantom rod positions from two MRI scanners were compared to that of CT imaging. The geometric accuracy of MR images from the Siemens scanner was greatly improved after the implementation of a special software patch provided by the manufacturer. In general, much better accuracy was achieved in the transverse plane where images were acquired. Most distortion was found around the periphery while least distortion was present in the middle and most other parts of the phantom. For most intracranial lesions undergoing stereotactic radiosurgery, accuracy of target localization can be achieved within size of a voxel, especially with the Siemens scanner. However, extra caution should be taken for imaging of peripheral lesions where the distortion is the greatest.
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Affiliation(s)
- Cheng Yu
- Department of Radiation Oncology (CY, ZP), Department of Neurosurgery (MLJA)University of Southern California, Keck School of Medicine1441 Eastlake AvenueLos AngelesCalifornia90033
| | - Zbigniew Petrovich
- Department of Radiation Oncology (CY, ZP), Department of Neurosurgery (MLJA)University of Southern California, Keck School of Medicine1441 Eastlake AvenueLos AngelesCalifornia90033
| | - Michael L. J. Apuzzo
- Department of Radiation Oncology (CY, ZP), Department of Neurosurgery (MLJA)University of Southern California, Keck School of Medicine1441 Eastlake AvenueLos AngelesCalifornia90033
| | - Gary Luxton
- Department of Radiation OncologyStanford University School of MedicineStanfordCalifornia94305
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40
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Walton L, Hampshire A, Vaughan P, Forster DMC, Kemeny AA, Radatz MWR. Distortion in magnetic resonance images obtained for stereotactic localization. J Neurosurg 2000. [DOI: 10.3171/jns.2000.93.supplement_3.0191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The purpose of this paper was to note a potential source of error in magnetic resonance (MR) imaging. Magnetic resonance images were acquired for stereotactic planning for GKS of a vestibular schwannoma in a female patient. The images were acquired using three-dimensional sequence, which has been shown to produce minimal distortion effects.
The images were transferred to the planning workstation, but the coronal images were rejected.
By examination of the raw data and reconstruction of sagittal images through the localizer side plate, it was clearly seen that the image of the square localizer system was grossly distorted.
The patient was returned to the MR imager for further studies and a metal clasp on her brassiere was identified as the cause of the distortion.
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41
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Vayssiere N, Hemm S, Zanca M, Picot MC, Bonafe A, Cif L, Frerebeau P, Coubes P. Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children. J Neurosurg 2000; 93:784-90. [PMID: 11059658 DOI: 10.3171/jns.2000.93.5.0784] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The actual distortion present in a given series of magnetic resonance (MR) images is difficult to establish. The purpose of this study was to validate an MR imaging-based methodology for stereotactic targeting of the internal globus pallidus during electrode implantation in children in whom general anesthesia had been induced. METHODS Twelve children (mean follow up 1 year) suffering from generalized dystonia were treated with deep brain stimulation by using a head frame and MR imaging. To analyze the influence of distortions at every step of the procedure, the geometrical characteristics of the frame were first controlled using the localizer as a phantom. Then pre- and postoperative coordinates of fixed anatomical landmarks and electrode positions, both determined with the head frame in place, were statistically compared. No significant difference was observed between theoretical and measured dimensions of the localizer (Student's t-test, ¿t¿ > 2.2 for 12 patients) in the x, y, and z directions. No significant differences were observed (Wilcoxon paired-sample test) between the following: 1) pre- and postoperative coordinates of the anterior commissure (AC) (deltax = 0.3+/-0.29 mm and deltay = 0.34+/-0.32 mm) and posterior commissure (PC) (deltax = 0.15+/-0.18 mm and deltay = 0.34+/-0.25 mm); 2) pre- and postoperative AC-PC distance (deltaL = 0.33+/-0.22 mm); and 3) preoperative target and final electrode position coordinates (deltax = 0.24+/-0.22 mm; deltay = 0.19+/-0.16 mm). CONCLUSIONS In the authors' center, MR imaging distortions did not induce detectable errors during stereotactic surgery in dystonic children. Target localization and electrode implantation could be achieved using MR imaging alone after induction of general anesthesia. The remarkable postoperative improvement in these patients confirmed the accuracy of the procedure (Burke-Marsden-Fahn Dystonia Rating Scale score delta = -83.8%).
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Affiliation(s)
- N Vayssiere
- Department of Pediatric Neurosurgery, University Hospital, Montpellier, France
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42
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Pollock BE, Kline RW, Stafford SL, Foote RL, Schomberg PJ. The rationale and technique of staged-volume arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 2000; 48:817-24. [PMID: 11020579 DOI: 10.1016/s0360-3016(00)00696-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Stereotactic radiosurgery is an effective management strategy for properly selected arteriovenous malformation (AVM) patients. However, the risk of postradiosurgical radiation-related injury generally limits this procedure to patients with AVMs of an average diameter of 3 cm or less. Radiosurgery of large AVMs in a planned staged fashion was undertaken to limit the radiation exposure to the surrounding normal brain. METHODS AND MATERIALS Between April 1997 and December 1999, 10 patients with a median AVM volume of 17.4 cm(3) (range, 7.4-53.3 cm(3)) underwent staged-volume radiosurgery (23 procedures). At the first radiosurgical procedure, the total volume of the AVM is estimated and a dose plan calculated that covers 10 cm(3)-15 cm(3), or one-half the nidus volume if the AVM is critically located (brainstem, thalamus, or basal ganglia). At 6-month intervals thereafter, radiosurgery was repeated to different portions of the AVM with the previous dose plan(s) being re-created utilizing intracranial landmarks to minimize radiation overlap. Radiosurgical procedures were continued until the entire malformation has been irradiated. RESULTS The radiation dosimetry of staged-volume AVM radiosurgery was compared to hypothetical single-session procedures for the 10 patients. Staged-volume radiosurgery decreased the 12-Gy volume by an average of 11.1% (range, 4.9-21%) (p < 0.001). The non-AVM 12-Gy volume was reduced by an average of 27.2% (range, 12.5-51.3%) (p < 0.001). DISCUSSION Staged-volume radiosurgery of large AVMs results in less radiation exposure to the adjacent brain. Further follow-up is needed to determine whether this technique provides a high rate of AVM obliteration while maintaining an acceptable rate of radiation-related complications.
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Affiliation(s)
- B E Pollock
- Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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Orth RC, Sinha P, Madsen EL, Frank G, Korosec FR, Mackie TR, Mehta MP. Development of a unique phantom to assess the geometric accuracy of magnetic resonance imaging for stereotactic localization. Neurosurgery 1999; 45:1423-9; discussion 1429-31. [PMID: 10598710 DOI: 10.1097/00006123-199912000-00030] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To test the spatial accuracy of coordinates generated from magnetic resonance imaging (MRI) scans, using the Brown-Roberts-Wells head frame and localizer system (Radionics, Inc., Burlington, MA). METHODS An anthropomorphic head phantom, consisting of a two-dimensional lattice of acrylic spheres (4-mm diameter) spaced 10 mm apart and embedded in a brain tissue-mimicking gelatin-agar gel, was constructed. The intersphere distances for the target lattice positions in MRI and computed tomographic scan sets were compared. The data sets were fused, and differences in fiducial marker and intraphantom target positions were measured. RESULTS Intersphere distances were identical for the MRI and computed tomographic scan sets (10 +/- 0.1 mm). Differences in fiducial marker positions [maximal lateral difference, 0.97 mm; mean absolute lateral difference, 0.69 +/- 0.22 mm; maximal anteroposterior (AP) difference, 1.99 mm; mean absolute AP difference, 1.29 +/- 0.67 mm] were correlated with differences in intraphantom target positions (maximal lateral difference, 0.83 mm; mean absolute lateral difference, 0.28 +/- 0.24 mm; maximal AP difference, -1.97 mm; mean absolute AP difference, 1.63 +/- 25 mm; maximal vertical difference, -0.73 mm; mean absolute vertical difference, 0.34 +/- 0.21 mm). This suggested that improper fiducial rod identification and the subsequent transformation to stereotactic coordinate space were the greatest sources of spatial uncertainty. CONCLUSION With computed tomographic data as the standard, these differences resulted in maximal and minimal composite uncertainties of 2.06 and 1.17 mm, respectively. The measured uncertainties exceed recommended standards for radiosurgery but allow the possible use of MRI-based stereotactic treatment planning for certain intracranial lesions, if the errors are corrected using appropriate software. Clinicians must recognize that error magnitudes vary for different systems, and they should perform systematic, scheduled, institutional error analyses as part of their ongoing quality assurance processes. This phantom provides one tool for measuring such variances.
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Affiliation(s)
- R C Orth
- Department of Human Oncology, University of Wisconsin, Madison, USA
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44
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Tozer-Loft SM, Walton L, Forster DM, Kemeny AA. An improved technique for comparing Gamma Knife dose-volume distributions in stereotactic radiosurgery. Phys Med Biol 1999; 44:1905-19. [PMID: 10473204 DOI: 10.1088/0031-9155/44/8/305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A function derived from the geometry of brachytherapy dose distributions is applied to stereotactic radiosurgery and an algorithm for the production of a novel dose-volume histogram, the Anderson inverse-square shifted dose-volume histogram (DVH), is proposed. The expected form of the function to be plotted is checked by calculating its value for single focus exposures, and its application to clinical examples of Gamma Knife treatments described. The technique is shown to provide a valuable tool for assessing the adequacy of radiosurgical plans and comparing and reporting dose distributions.
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Affiliation(s)
- S M Tozer-Loft
- Department of Medical Physics, Weston Park Hospital, Sheffield, UK.
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45
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Starr PA, Vitek JL, DeLong M, Bakay RA. Magnetic resonance imaging-based stereotactic localization of the globus pallidus and subthalamic nucleus. Neurosurgery 1999; 44:303-13; discussion 313-4. [PMID: 9932883 DOI: 10.1097/00006123-199902000-00031] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To optimize the accuracy of initial stereotactic targeting for movement disorders surgery, we performed stereotactic localization of the internal segment of the globus pallidus (GPi) and subthalamic nucleus (STN) using magnetic resonance imaging protocols in which the borders of these nuclei were directly visualized. METHODS Fifty-one consecutive cases using the pallidal target and six using the subthalamic target were studied. Localization of these nuclei was performed using the Leksell stereotactic head frame and inversion recovery sequences (GPi) or T2-weighted spin echo sequences (STN). Targeting accuracy and individual variation in the spatial coordinates of these structures were independently measured by identification of nuclear boundaries during multiple microelectrode penetrations. RESULTS The lateral and vertical coordinates of an atlas-defined point in the GPi, with respect to the line between the anterior and posterior commissures, was highly variable. Initial targeting the GPi based on direct visualization of the target boundaries (external medullary lamina and optic tract) resulted in greater precision than would be expected using fixed anterior and posterior commissure-based coordinates. Initial targeting the STN using magnetic resonance imaging was sufficiently precise to place the initial microelectrode penetration within STN in all six cases. CONCLUSION Magnetic resonance imaging-based initial stereotactic targeting of the GPi, based on direct visualization of the target boundaries, is useful to improve target accuracy over that of purely indirect anterior and posterior commissure-based targeting methods. Initial targeting of the STN was reliably accomplished by direct visualization. However, there remains sufficient variability that the final target location in both GPi and STN required electrophysiological mapping in all cases.
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Affiliation(s)
- P A Starr
- Department of Neurosurgery, University of California, San Francisco 94143, USA
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Dorward NL, Alberti O, Palmer JD, Kitchen ND, Thomas DG. Accuracy of true frameless stereotaxy: in vivo measurement and laboratory phantom studies. Technical note. J Neurosurg 1999; 90:160-8. [PMID: 10413173 DOI: 10.3171/jns.1999.90.1.0160] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the results of accuracy measurements, obtained in both laboratory phantom studies and an in vivo assessment, for a technique of frameless stereotaxy. An instrument holder was developed to facilitate stereotactic guidance and enable introduction of frameless methods to traditional frame-based procedures. The accuracy of frameless stereotaxy was assessed for images acquired using 0.5-tesla or 1.5-tesla magnetic resonance (MR) imaging or 2-mm axial, 3-mm axial, or 3-mm helical computerized tomography (CT) scanning. A clinical series is reported in which biopsy samples were obtained using a frameless stereotactic procedure, and the accuracy of these procedures was assessed using postoperative MR images and image fusion. The overall mean error of phantom frameless stereotaxy was found to be 1.3 mm (standard deviation [SD] 0.6 mm). The mean error for CT-directed frameless stereotaxy was 1.1 mm (SD 0.5 mm) and that for MR image-directed procedures was 1.4 mm (SD 0.7 mm). The CT-guided frameless stereotaxy was significantly more accurate than MR image-directed stereotaxy (p = 0.0001). In addition, 2-mm axial CT-guided stereotaxy was significantly more accurate than 3-mm axial CT-guided stereotaxy (p = 0.025). In the clinical series of 21 frameless stereotactically obtained biopsies, all specimens yielded the appropriate diagnosis and no complications ensued. Early postoperative MR images were obtained in 16 of these cases and displacement of the biopsy site from the intraoperative target was determined by fusion of pre- and postoperative image data sets. The mean in vivo linear error of frameless stereotactic biopsy sampling was 2.3 mm (SD 1.9 mm). The mean in vivo Euclidean error was 4.8 mm (SD 2 mm). The implications of these accuracy measurements and of error in stereotaxy are discussed.
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Affiliation(s)
- N L Dorward
- University Department of Neurosurgery, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Van Roost D, Solymosi L, Schramm J, van Oosterwyck B, Elger CE. Depth electrode implantation in the length axis of the hippocampus for the presurgical evaluation of medial temporal lobe epilepsy: a computed tomography-based stereotactic insertion technique and its accuracy. Neurosurgery 1998; 43:819-26; discussion 826-7. [PMID: 9766309 DOI: 10.1097/00006123-199810000-00058] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE An individualized computed tomography-based stereotactic technique for the longitudinal insertion of intrahippocampal electrodes is presented and its accuracy described. METHODS The technique makes use of one well reproducible target in the hippocampal head and of the approximate inclination of the anteroposterior length axis of the hippocampus, for which the orbital floor is taken as an auxiliary landmark. It was used in 141 patients with medically intractable complex partial seizures. In 106 patients, magnetic resonance imaging (MRI) was available for assessment of implantation accuracy. Each of the 212 electrodes was plotted on topographic drawings and its goodness of fit rated. RESULTS Whereas hippocampal head and body were hit by 97 and 96% of the electrodes, respectively, the amygdala was hit by only 75% of the electrodes and mainly at its basal margin. For 93% of the electrodes, the inclination in a sagittal plane corresponded exactly to that of the hippocampus. The implantation morbidity amounted to 5.7%, whereas permanent neurological deficit occurred in one (0.7%) of the 141 patients. CONCLUSION This computed tomography-based protocol proved to be reliable and hence can be considered as an adequate alternative to MRI-based stereotactic implantation if MRI is not available or if a single MRI-based stereotactic set-up is unreliable because of intolerable distortions.
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Affiliation(s)
- D Van Roost
- Department of Neurosurgery, University of Bonn, Germany
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