Multimodal Image Fusion in Ultrasound-Based Neuronavigation: Improving Overview and Interpretation by Integrating Preoperative MRI with Intraoperative 3D Ultrasound

Lindseth, Frank; Kaspersen, Jon; Ommedal, Steinar; Langø, Thomas; Bang, Jon; Hokland, J.H.; Unsgaard, Geirmund; Hernes, Toril A. Nagelhus

doi:10.3109/10929080309146040

Cited by 68 publications

(42 citation statements)

References 58 publications

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“…So, several strategies for the detection and compensation of this phenomenon have been developed. Most of them are based on intraoperative images obtained by MR [22,23] , CT [31] , or ultrasound [32,33] . We favor the concept of intraoperative MR imaging and updating the frameless stereotactic system with these data [21,23,24] .…”

Section: Discussionmentioning

confidence: 99%

Application Accuracy of Automatic Registration in Frameless Stereotaxy

Rachinger

Keller

Ganslandt

et al. 2006

Stereotact Funct Neurosurg

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Objective: We compared the application accuracy of an infrared-based neuronavigation system when used with a novel automatic registration with its application accuracy when standard fiducial-based registration is performed. Methods: The automatic referencing tool is based on markers that are integrated in the headrest holder we routinely use in our intraoperative magnetic resonance imaging (MRI) setting and can be detected by the navigation software automatically. For navigation targeting we used a Plexiglas phantom with 32 notched rods of different heights. The phantom was fixed in the head holder and multiple optimized gradient echo slices containing the clamp-integrated markers were acquired. After that we measured a T₁ MPRAGE sequence with a slice thickness of 1.0 mm for navigation. The deepest points of the surface of the rods were defined as target points in image space. In three measurement series we referenced the phantom once with 4, once with 7 fiducials and twice automatically. In one series we performed only one automatic registration. The localization error was measured 3 times per rod and registration. Results: The median localization errors for standard registration with 7 fiducials were between 1.2 and 3.05 mm. With 4 fiducials, medians were in the range from 1.87 to 2.21 mm. For the automatic registration we obtained median localization errors between 0.88 and 2.13 mm. In 6 of the 8 samples that were compared the automatic registration showed an application accuracy that was highly significantly better (p < 0.001 in most cases) than that of fiducial-based standard registration. Conclusion: The application accuracy found for automatic referencing is at least not worse than that for standard registration no matter whether 4 or 7 fiducial markers were used. Therefore, its use in the operating room is feasible. In combination with intraoperative MRI it may become a favorable alternative to standard fiducial-based registration especially when an intraoperative update of navigation data is necessary.

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Section: Discussionmentioning

confidence: 99%

Application Accuracy of Automatic Registration in Frameless Stereotaxy

Rachinger

Keller

Ganslandt

et al. 2006

Stereotact Funct Neurosurg

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“…In spite of these developments and modern visualisation techniques [58], enthusiasm for intraoperative US to date has been disappointing.…”

Section: Current Challengesmentioning

confidence: 99%

Neuronavigation and surgery of intracerebral tumours

et al. 2006

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Approximately four decades after the successful clinical introduction of framebased stereotactic neurosurgery by Spiegel and Wycis, frameless stereotaxy emerged to enable more elaborate image guidance in open neurosurgical procedures. Frameless stereotaxy, or neuronavigation, relies on one of several different localizing techniques to determine the position of an operative instrument relative to the surgical field, without the need for a coordinate frame rigidly fixed to the patients' skull. Currently, most systems are based on the optical triangulation of infrared light sources fixed to the surgical instrument. In its essence, a navigation system is a three-dimensional digitiser that correlates its measurements to a reference data set, i.e. a preoperatively acquired CT or MRI image stack. This correlation is achieved through a patient-to-image registration procedure resulting in a mathematical transformation matrix mapping each position in 'world space' onto 'image space'. Thus, throughout the remainder of the surgical procedure, the position of the surgical instrument can be demonstrated on a computer screen, relative to the CT or MRI images. Though neuronavigation has become a routinely used addition to the neurosurgical armamentarium, its impact on surgical results has not yet been examined sufficiently. Therefore, the surgeon is left to decide on a case-by-case basis whether to perform surgery with or without neuronavigation. Future challenges lie in improvement of the interface between the surgeon and the neuronavigator and in reducing the brainshift error, i.e. inaccuracy introduced by changes in tissue positions after image acquisition.

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“…Radiation oncologists have used fusion of US images with CT scans for radiotherapy [22] and prostate brachytherapy [8,9]. Its use also has been documented in neurosurgery for intraoperative localization [16]. Perhaps the field that has made the most use of this technology is hepatic surgery where intraoperative localization by US is essential to treatment.…”

Section: Introductionmentioning

confidence: 99%

2011 Mid-America Orthopaedic Association Dallas B. Phemister Physician in Training Award: Can Musculoskeletal Tumors be Diagnosed with Ultrasound Fusion-Guided Biopsy?

Khalil

Mott

Parsons

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Percutaneous biopsy for musculoskeletal tumors commonly relies on imaging adjuncts including ultrasound (US), CT, or MRI. These modalities however have disadvantages (US) or are cumbersome, not universally available, and costly (CT and MRI). US fusion is a novel technique that fuses previously obtained CT or MRI data with real-time US, which allows biopsies to be performed in an US suite. It has proven useful in various body systems but musculoskeletal applications remain scarce. Our goal is to evaluate the fusion technology and determine its ability to diagnose musculoskeletal tumors. Questions/Purposes We determined whether biopsies performed via US fusion compared with CT guidance provide equivalent diagnostic yield and accuracy and allow quicker biopsy scheduling and procedure times. Methods Forty-seven patients were assigned to undergo either US fusion (with MR, n = 16 or CT, n = 15) or CTguided biopsies (n = 16). We evaluated adequacy of the histologic specimen (diagnostic yield) and correlation with surgical pathology (diagnostic accuracy). We determined scheduling times and lengths of the biopsy. Results US fusion and CT-guided biopsy groups had comparable diagnostic yields (CT = 94%; US/MRI = 94%; US/CT = 93%) and accuracy (CT = 83%; US/ MRI = 90%; US/CT = 100%). US fusion biopsies were faster to schedule and perform. All procedures were safe with minimal complications.Conclusions US fusion provides a high diagnostic yield and accuracy comparable to CT-guided biopsy while performed in the convenience of an US suite. This may have resulted in the observed faster scheduling and biopsy times. Level of Evidence Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Multimodal Image Fusion in Ultrasound-Based Neuronavigation: Improving Overview and Interpretation by Integrating Preoperative MRI with Intraoperative 3D Ultrasound

Abstract: We believe that image fusion between intraoperative 3D ultrasound and preoperative MRI might improve the quality of the surgical procedure and hence also improve the patient outcome.

Cited by 68 publications

References 58 publications

Application Accuracy of Automatic Registration in Frameless Stereotaxy

Application Accuracy of Automatic Registration in Frameless Stereotaxy

Neuronavigation and surgery of intracerebral tumours

2011 Mid-America Orthopaedic Association Dallas B. Phemister Physician in Training Award: Can Musculoskeletal Tumors be Diagnosed with Ultrasound Fusion-Guided Biopsy?

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