Computer-assisted 3D ultrasound-guided neurosurgery: technological contributions, including multimodal registration and advanced display, demonstrating future perspectives

Hernes, Toril A. Nagelhus; Lindseth, Frank; Selbekk, Tormod; Wollf, Arild; Solberg, Ole Vegard; Harg, Erik; Rygh, Ola M.; Tangen, Geir; Rasmussen, Ingvill; Augdal, Sigmund; Couweleers, Fred; Unsgaard, Geirmund

doi:10.1002/rcs.68

Cited by 30 publications

(5 citation statements)

References 47 publications

(45 reference statements)

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“…Thus, it can be difficult for surgeons to maximally benefit from 2D iUS in neurosurgical procedures. Integrating preoperative MRI with 3D iUS in neuronavigation helps resolve these orientation challenges of 2D iUS (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Challenges and Opportunities of Intraoperative 3D Ultrasound With Neuronavigation in Relation to Intraoperative MRI

et al. 2021

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IntroductionNeuronavigation greatly improves the surgeon’s ability to approach, assess and operate on brain tumors, but tends to lose its accuracy as the surgery progresses and substantial brain shift and deformation occurs. Intraoperative MRI (iMRI) can partially address this problem but is resource intensive and workflow disruptive. Intraoperative ultrasound (iUS) provides real-time information that can be used to update neuronavigation and provide real-time information regarding the resection progress. We describe the intraoperative use of 3D iUS in relation to iMRI, and discuss the challenges and opportunities in its use in neurosurgical practice.MethodsWe performed a retrospective evaluation of patients who underwent image-guided brain tumor resection in which both 3D iUS and iMRI were used. The study was conducted between June 2020 and December 2020 when an extension of a commercially available navigation software was introduced in our practice enabling 3D iUS volumes to be reconstructed from tracked 2D iUS images. For each patient, three or more 3D iUS images were acquired during the procedure, and one iMRI was acquired towards the end. The iUS images included an extradural ultrasound sweep acquired before dural incision (iUS-1), a post-dural opening iUS (iUS-2), and a third iUS acquired immediately before the iMRI acquisition (iUS-3). iUS-1 and preoperative MRI were compared to evaluate the ability of iUS to visualize tumor boundaries and critical anatomic landmarks; iUS-3 and iMRI were compared to evaluate the ability of iUS for predicting residual tumor.ResultsTwenty-three patients were included in this study. Fifteen patients had tumors located in eloquent or near eloquent brain regions, the majority of patients had low grade gliomas (11), gross total resection was achieved in 12 patients, postoperative temporary deficits were observed in five patients. In twenty-two iUS was able to define tumor location, tumor margins, and was able to indicate relevant landmarks for orientation and guidance. In sixteen cases, white matter fiber tracts computed from preoperative dMRI were overlaid on the iUS images. In nineteen patients, the EOR (GTR or STR) was predicted by iUS and confirmed by iMRI. The remaining four patients where iUS was not able to evaluate the presence or absence of residual tumor were recurrent cases with a previous surgical cavity that hindered good contact between the US probe and the brain surface.ConclusionThis recent experience at our institution illustrates the practical benefits, challenges, and opportunities of 3D iUS in relation to iMRI.

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Section: Introductionmentioning

confidence: 99%

Challenges and Opportunities of Intraoperative 3D Ultrasound With Neuronavigation in Relation to Intraoperative MRI

et al. 2021

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“…US is highly used for both open and minimally invasive procedures with an array of different probes and newly developed contrast agents. 15 Because of many of these advantages, US imaging has been combined with other techniques, such as fluorescence molecular tomography, 16 MRI for intraoperative guidance, 17,18 fluorescence lifetime imaging for oral cancer evaluation, 19 and intravascular photoacoustic imaging for characterization of atherosclerosis. 20 In summary, US is used so often with other modalities because it provides the clinicians with interactive feedback.…”

Section: Related Workmentioning

confidence: 99%

Three-dimensional multimodal medical imaging system based on freehand ultrasound and structured light

et al. 2021

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We propose a three-dimensional (3D) multimodal medical imaging system that combines freehand ultrasound and structured light 3D reconstruction in a single coordinate system without requiring registration. To the best of our knowledge, these techniques have not been combined as a multimodal imaging technique. The system complements the internal 3D information acquired with ultrasound with the external surface measured with the structured light technique. Moreover, the ultrasound probe's optical tracking for pose estimation was implemented based on a convolutional neural network. Experimental results show the system's high accuracy and reproducibility, as well as its potential for preoperative and intraoperative applications. The experimental multimodal error, or the distance from two surfaces obtained with different modalities, was 0.12 mm. The code is available in a Github repository. © 2021 Society of Photo-Optical Instrumentation Engineers (SPIE)

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“…During intraoperative application, ultrasound allows the surgeon to localize a lesion in real-time even before the opening of the dura. This facilitates the surgical access and is a useful add-on to neuronavigation [36,37]. In addition, UPI enables the surgeon to assess tumor enhancement, vascularity, and perfusion, and to control for completeness of resection [38][39][40].…”

Section: Clinical Applications Up To Date and Future Indicationsmentioning

confidence: 99%

Twenty Years of Cerebral Ultrasound Perfusion Imaging—Is the Best yet to Come?

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Fung

Niesen

et al. 2020

JCM

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Over the past 20 years, ultrasonic cerebral perfusion imaging (UPI) has been introduced and validated applying different data acquisition and processing approaches. Clinical data were collected mainly in acute stroke patients. Some efforts were undertaken in order to compare different technical settings and validate results to gold standard perfusion imaging. This review illustrates the evolution of the method, explicating different technical aspects and milestones achieved over time. Up to date, advancements of ultrasound technology as well as data processing approaches enable semi-quantitative, gold standard proven identification of critically hypo-perfused tissue in acute stroke patients. The rapid distribution of CT perfusion over the past 10 years has limited the clinical need for UPI. However, the unexcelled advantage of mobile application raises reasonable expectations for future applications. Since the identification of intracerebral hematoma and large vessel occlusion can also be revealed by ultrasound exams, UPI is a supplementary multi-modal imaging technique with the potential of pre-hospital application. Some further applications are outlined to highlight the future potential of this underrated bedside method of microcirculatory perfusion assessment.

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Computer-assisted 3D ultrasound-guided neurosurgery: technological contributions, including multimodal registration and advanced display, demonstrating future perspectives

Cited by 30 publications

References 47 publications

Challenges and Opportunities of Intraoperative 3D Ultrasound With Neuronavigation in Relation to Intraoperative MRI

Challenges and Opportunities of Intraoperative 3D Ultrasound With Neuronavigation in Relation to Intraoperative MRI

Three-dimensional multimodal medical imaging system based on freehand ultrasound and structured light

Twenty Years of Cerebral Ultrasound Perfusion Imaging—Is the Best yet to Come?

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