Intraoperative Magnetic Resonance Imaging at 3-T Using a Dual Independent Operating Room-Magnetic Resonance Imaging Suite

Jankovski, Aleksandar; Francotte, Frédéric; Vaz, G.; Fomekong, Edward; Duprez, Thierry; Boven, Michel Van; Docquier, Marie-Agnès; Hermoye, Laurent; Cosnard, Guy; Raftopoulos, Christian

doi:10.1227/01.neu.0000324897.59311.1c

Cited by 54 publications

(32 citation statements)

References 24 publications

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“…3,4,6,15,26 Therefore we tested the applicability of intraoperative long-TE single-voxel proton MRS (ioMRS) for imaging the T2-hyperintense areas at the tumor resection border and studied the correlation between the imaging diagnosis and tissue histopathology at the voxel of interest (VOI).…”

Section: ©Aans 2013mentioning

confidence: 99%

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Pamir

Özduman²,

Yıldız

et al. 2013

JNS

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M axiMal safe resection is currently the most effective form of therapy for hemispheric LGGs and patients benefit from the extent of resection. 1,7,16,20 Intraoperative MRI has been used with success in LGG surgery, and the technique has been shown to both increase the extent of resection 2,[10][11][12]21,22,25 and significantly decrease recurrence and death rate in patients with LGGs. 2During LGG surgery, ioMRI can detect residual tumor tissue that cannot be identified by visual inspection or intraoperative ultrasonography. 8,15,25 The tumor mass is defined as the T2-hyperintense area and the extent of resection is based on comparison of intraoperatively acquired T2-weighted images with preoperative ones. However, especially after resection of large LGGs with mass effect, intraoperative images may show T2-hyperintense areas at the resection border, and a differential diagnosis between tumoral and nontumoral tissue may be difficult.15 The difficulty lies in that both tumor and nontumoral changes such as infarction, edema, or iatrogenic contusion or other surgically induced changes can appear similarly as T2 hyperintensities on MRI. This is a potential limiting factor for an optimum resection in certain Object. The authors had previously shown that 3-T intraoperative MRI (ioMRI) detects residual tumor tissue during low-grade glioma and that it helps to increase the extent of resection. In a proportion of their cases, however, the ioMRI disclosed T2-hyperintense areas at the tumor resection border after the initial resection attempt and prompted a differential diagnosis between residual tumor and nontumoral changes. To guide this differential diagnosis the authors used intraoperative long-TE single-voxel proton MR spectroscopy (ioMRS) and tested the correlation of these findings with findings from pathological examination of resected tissue.Methods. Patients who were undergoing surgery for hemispheric or insular WHO Grade II gliomas and were found to have T2 changes around the resection cavity at the initial ioMRI were prospectively examined with ioMRS and biopsies were taken from corresponding localizations. In 14 consecutive patients, the ioMRS diagnosis in 20 voxels of interest was tested against the histopathological diagnosis. Intraoperative diffusion-weighted imaging (ioDWI) was also performed, as a part of the routine imaging, to rule out surgically induced changes, which could also appear as T2 hyperintensity.Results. Presence of tumor was documented in 14 (70%) of the 20 T2-hyperintense areas by histopathological examination. The sensitivity of ioMRS for identifying residual tumor was 85.7%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 75%. The specificity of ioDWI for surgically induced changes was high (100%), but the sensitivity was only 60%.Conclusions. This is the first clinical series to indicate that ioMRS can be used to differentiate residual tumor from nontumoral changes around the resection cavity, with high sensitivity and specificity. ...

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Section: ©Aans 2013mentioning

confidence: 99%

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Pamir

Özduman²,

Yıldız

et al. 2013

JNS

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“…Recent advances in modalities can provide useful information to ensure safe operations. Intraoperative MR imaging (iMRI) manifests the degree of tumor removal during surgery (7,(9)(10)(11)14) and threedimensional (3D) endoscopy offers a steric view that allows the recognition of neurovascular structures around the parasellar area (16).…”

Section: Introductionmentioning

confidence: 99%

Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma

Komatsu¹,

Aoki²,

Osakabe³

et al. 2014

Turkish Neurosurgery

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We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure.A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.KEywords: Chiasmatic cistern, Intraoperative MRI, Suprasellar tumor, Tuberculum sellae ÖZGenişletilmiş endoskopik endonazal yaklaşım kullanılarak güvenli bir şekilde çıkartılan bir supra-diyafragmatik ektopik hipofiz adenomu tanımlanmakta ve bu tür işlemde üç boyutlu (3B) endoskopi ve intraoperatif manyetik rezonans görüntülemenin (MRG) değeri tartışılmaktadır.Bitemporal hemianopsili, 61 yaşında bir erkek hasta hastanemize sevk edildi ve MRG'de optik kiazmayı sıkıştıran, kontrast tutan bir suprasellar tümör görüldü. Tümör, planum sfenoidale üzerine uzanmaktaydı ve sağ internal karotid arteri kısmen çevrelemişti. Endokrin değerlendirme normal pitüiter işlev gösterdi. İntraoperatif manyetik rezonans görüntüleme (MRG) odasında bir 3D endoskop kullanılarak genişletilmiş endoskopik endonazal yaklaşım gerçekleştirildi. Tümör diyafragma sella üzerinde bulunuyordu ve normal hipofiz bezinden ayrılmıştı. Patolojik bulgular işlev görmeyen bir hipofiz adenom düşündürüyordu ve tümöre bu şekilde bir supra-diyafragmatik ektopik hipofiz adenom tanısı konuldu. İntraoperatif MRG dural açıklığı minimuma indirmek için faydalı bilgiler sağladı ve supra-diyafragmatik ektopik hipofiz adenom intraoperatif MRG odasında 3B endoskopi kılavuzluğu altında genişletilmiş endoskopik endonazal yaklaşımla kompleks nörovasküler yapıdan çıkarıldı. Supra-diyafragmatik ektopik hipofiz adenomun güvenli ve etkin bir şekilde çıkarılması 3B endoskopi ve intraoperatif MRG tarafından sağlanan görsel bilgiler ve genişletilmiş endoskopik endonazal yaklaşım yoluyla gerçekleştirildi.

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“…Very few ultrahigh-field systems have been reported in the literature so far, including the 3-T-Philips systems at University of Minnesota [10,16], the 3-T-Siemens at Acibadem University, Turkey [17,18] and finally the second Philips system at Cliniques Universitaires St-Luc, Université Catholique de Louvain, Belgium [19]. The first clinical LGG series was reported by our institution and showed an increased gross total resection rate comparable to the results obtained by low-and high-field systems [17].…”

Section: Necmettin Pamir MD Editorial Pamir and öZdumanmentioning

confidence: 99%

“…The latest system by Siemens, installed at our institution, again used the twin-room philosophy to reduce costs by allocating the equipment to diagnostic out-patient imaging at times when MRI is not needed intraoperatively [17,18]. A similar design was also adopted by the Philips system installed in Belgium [19].…”

Section: "Current Intraoperative Mri Technology Has Verymentioning

confidence: 99%

3-T ultrahigh-field intraoperative MRI for low-grade glioma resection

Pamir¹,

Özduman²

2009

Expert Review of Anticancer Therapy

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Intraoperative Magnetic Resonance Imaging at 3-T Using a Dual Independent Operating Room-Magnetic Resonance Imaging Suite

Cited by 54 publications

References 24 publications

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma

3-T ultrahigh-field intraoperative MRI for low-grade glioma resection

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