3 Tesla intraoperative MRI for brain tumor surgery

Ginat, Daniel Thomas; Swearingen, Brooke; Curry, William T.; Cahill, Daniel P.; Madsen, Joseph R.; Schaefer, Pamela W.

doi:10.1002/jmri.24380

Cited by 48 publications

(36 citation statements)

References 53 publications

(82 reference statements)

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“…[1] The ability of obtaining this sequence with intraoperative MRI further enhances resection control by providing a timely evaluation of tumor residual that can be removed additionally. [2][3][4] Tomography, (FET-PET) may potentially better depict high grade glioma tissue, but lower spatial resolution and limited clinical availability are remaining challenges. [5] Cerebrovascular reactivity (CVR) is a functional parameter that can be assessed with MRI by obtaining Blood Oxygen-Level Dependent (BOLD) volumes.…”

Section: Introductionmentioning

confidence: 99%

Altered intraoperative cerebrovascular reactivity in brain areas of high-grade glioma recurrence

Fierstra

Niftrik

Piccirelli

et al. 2016

Magnetic Resonance Imaging

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INTRODUCTION: Current MRI sequences are limited in identifying brain areas at risk for high grade glioma recurrence. We employed intraoperative 3-Tesla functional MRI to assess cerebrovascular reactivity (CVR) after high-grade glioma resection and analyzed regional CVR responses in areas of tumor recurrence on clinical follow-up imaging. METHODS: Five subjects with high-grade glioma that underwent an intraoperative Blood Oxygen-Level Dependent (BOLD) MRI CVR examination and had a clinical follow-up of at least 18 months were selected from a prospective database. For this study, location of tumor recurrence was spatially matched to the intraoperative imaging to assess CVR response in that particular area. CVR is defined as the percent BOLD signal change during repeated cycles of apnea. RESULTS: Of the 5 subjects (mean age 44, 2 females), 4 were diagnosed with a WHO grade III and 1 subject with a WHO grade IV glioma. Three subjects exhibited a tumor recurrence on clinical follow-up MRI (mean: 15 months). BOLD CVR measured in the spatially matched area of tumor recurrence was on average 94% increased (range -32% to 183%) as compared to contralateral hemisphere CVR response, 1.50±0.81 versus 1.03±0.46 respectively (p=0.31). CONCLUSION: For this first analysis in a small cohort, we found altered intraoperative CVR in brain areas exhibiting high grade glioma recurrence on clinical follow-up imaging. Methods: Five subjects with high-grade glioma that underwent an intraoperative BloodOxygen-Level Dependent (BOLD) MRI CVR examination and had a clinical follow-up of at least 18 months were selected from a prospective database. For this study, location of tumor recurrence was spatially matched to the intraoperative imaging to assess CVR response in that particular area. CVR is defined as the percent BOLD signal change during repeated cycles of apnea.Results: Of the 5 subjects (mean age 44, 2 females), 4 were diagnosed with a WHO grade III and 1 subject with a WHO grade IV glioma. Three subjects exhibited a tumor recurrence on clinical follow-up MRI (mean: 15 months). BOLD CVR measured in the spatially matched area of tumor recurrence was on average 64% increased (range -29% to 123%) as compared to whole brain CVR response, 1.50±0.81 versus 1.09±0.37 respectively. Conclusion:For this first analysis in a small cohort, we found altered intraoperative CVR in brain areas exhibiting high grade glioma recurrence on clinical follow-up imaging.

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Section: Introductionmentioning

confidence: 99%

Altered intraoperative cerebrovascular reactivity in brain areas of high-grade glioma recurrence

Fierstra

Niftrik

Piccirelli

et al. 2016

Magnetic Resonance Imaging

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“…Nevertheless, the advantages of iMRI with a standard head could include the detection of larger tumor remnants and cerebrospinal fluid leakage. 12 …”

Section: Discussionmentioning

confidence: 99%

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

Chittiboina

Talagala²,

Merkle

et al. 2016

JNS

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OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing’s disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed. METHODS Five cadaver heads were used for preclinical testing of the ESC. The ESC (a double-turn, 12-mm-diameter surface coil made from 1-mm-diameter copper wire) was developed to obtain images in a 1.5-T MR scanner. The ESC was placed (via a standard sublabial TSS approach) on the anterior sella face. Clinical MR scans were obtained using the 8-channel head coil and ESC as the receiver coils. Using the ESC, ultra–high-resolution, 3D, balanced fast field echo (BFFE) and T1-weighted imaging were performed at resolutions of 0.25 × 0.25 × 0.50 mm3 and 0.15 × 0.15 × 0.30 mm3, respectively. RESULTS Region-of-interest analysis indicated a 10-fold increase in the signal-to-noise ratio (SNR) of the pituitary when using the ESC compared with the 8-channel head coil. ESC-related improvements (p < 0.01) in the SNR were inversely proportional to the distance from the ESC tip to the anterior pituitary gland surface. High-resolution BFFE MR imaging obtained using ESC revealed a number of anatomical features critical to pituitary surgery that were not visible on 8-channel MR imaging, including the pituitary capsule, the intercavernous sinus, and microcalcifications in the pars intermedia. These ESC imaging findings were confirmed by the pathological correlation with whole-mount pituitary sections. CONCLUSIONS ESC can significantly improve SNR in the sellar region intraoperatively using current 1.5-T MR imaging platforms. Improvement in SNR can provide images of the sella and surrounding structures with unprecedented resolution. Clinical use of this ESC may allow for MR imaging detection of previously occult pituitary adenomas and identify microscopic invasion of the dura or cavernous sinus.

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“…Currently, iMRI is useful for optimizing the resection of primary glial neoplasms with poorly-defined borders and detecting early complications by allowing the surgeon to visualize progress and adapt the surgical plan in real time [16]. The drawbacks associated with this technique are the addition of significant surgical time, increased operating room costs, and difficulty interpreting intra-operative contrast images due to iatrogenic disruption of the blood brain barrier.…”

Section: Mri-guided Resectionmentioning

confidence: 98%

Future directions of operative neuro-oncology

et al. 2016

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Recent technological advancements have drastically improved the safety and surgical precision of operative neuro-oncology. These include techniques for avoiding critical functional structures through pre-operative mapping and trajectory planning, as well the development and refinement of minimally invasive surgical approaches. Innovations in intra-operative tumor mapping, and post-resection tumor ablation have further combined to improve surgical outcomes. This review highlights such advancements and discusses future directions within operative neuro-oncology.

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3 Tesla intraoperative MRI for brain tumor surgery

Cited by 48 publications

References 53 publications

Altered intraoperative cerebrovascular reactivity in brain areas of high-grade glioma recurrence

Altered intraoperative cerebrovascular reactivity in brain areas of high-grade glioma recurrence

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

Future directions of operative neuro-oncology

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