Karawun: a software package for assisting evaluation of advances in multimodal imaging for neurosurgical planning and intraoperative neuronavigation

Abstract

Purpose The neuroimaging research community—which includes a broad range of scientific, medical, statistical, and engineering disciplines—has developed many tools to advance our knowledge of brain structure, function, development, aging, and disease. Past research efforts have clearly shaped clinical practice. However, translation of new methodologies into clinical practice is challenging. Anything that can reduce these barriers has the potential to improve the rate at which research outcomes can contribute to clinical practice. In this article, we introduce Karawun, a file format conversion tool, that has become a key part of our work in translating advances in diffusion imaging acquisition and analysis into neurosurgical practice at our institution. Methods Karawun links analysis workflows created using open-source neuroimaging software, to Brainlab (Brainlab AG, Munich, Germany), a commercially available surgical planning and navigation suite. Karawun achieves this using DICOM standards supporting representation of 3D structures, including tractography streamlines, and thus offers far more than traditional screenshot or color overlay approaches. Results We show that neurosurgical planning data, created from multimodal imaging data using analysis methods implemented in open-source research software, can be imported into Brainlab. The datasets can be manipulated as if they were created by Brainlab, including 3D visualizations of white matter tracts and other objects. Conclusion Clinicians can explore and interact with the results of research neuroimaging pipelines using familiar tools within their standard clinical workflow, understand the impact of the new methods on their practice and provide feedback to methods developers. This capability has been important to the translation of advanced analysis techniques into practice at our institution.

Tractography-based navigated TMS language mapping protocol

“…Transformation to the T1 image was done using the MRtrix3 framework (26). The transformed T1 image with the corresponding endpoints was uploaded into Brainlab using Karawun (45) in order to re-import them into Brainlab at the conclusion of the mapping.> The image was uploaded into the Nexstim TMS system and AF endpoints were visualized. The endpoints were shown as white points projected in the T1 image after the transformation.…”

Fibre orientation atlas guided rapid segmentation of white matter tracts

“…Nonetheless, there is growing consensus that (pending appropriate regulatory approval) the clinical community ought to adopt probabilistic, non‐DT tractography (Beare et al, 2022 ; Petersen et al, 2017 ; Yang et al, 2021 ), given, among other issues, the low sensitivity of DT deterministic tractography particularly around lesions (Ashmore et al, 2020 ). There is evidence that a shift is underway, at least in the context of presurgical planning (Toescu et al, 2020 ), although there is the question of whether the adoption of advanced tractography is being driven from the supply or demand side.…”