Real-time magnetic resonance imaging-guided frameless stereotactic brain biopsy: technical note

Abstract

Despite their ubiquitous use, both frame-based and frameless stereotactic biopsies rely on preoperative images with intraoperative anatomical or fiducial registration to reach deep brain targets based on precalculated measurements in 3D space. 1,3,6,8,14,15,23 The primary limitations of these approaches are the inability to account for the shift of intracranial structures (reduces accuracy of the biopsy at the target), the inability to adapt to vital structures along the needle trajectory in real-time, and the lack of intraoperative imaging confirmation of the accuracy of the biopsy target. 5,7,13,22 Moreover, miscalculations or technical misalignment of hardware during biopsy can result in intraoperative morbidity. 6,10 Recent data indicate that the diagnostic accuracy of stereotaxy using conventional preoperative neuronavigation may be lower than previously reported (accuracy range 51%-91%). 3,4,8 To overcome these limitations, technology has been developed that now permits the integration of intraoperative MRI (iMRI) with frameless stereotaxy. The resolution and real-time feedback of this iMRI technology has been demonstrated in phantom experiments, 12,18 nonhuman primate studies, 16,17 drug infusion cannula placement, 2 and placement of deep brain stimulator leads. 9,11,20,21 Application of this technology to stereotactic brain biopsy could eliminate misdiagnosis secondary to faulty targeting, provide realtime adaptability for needle trajectory, confirm accurate biopsy cannula position, and provide immediate imaging of complications. To determine the feasibility, accuracy, and safety of real-time MRI-guided brain biopsy, we analyzed the results in consecutive brain biopsy cases using this paradigm. Methods PatientsConsecutive patients who underwent stereotactic brain abbreviatioNs GBM = glioblastoma multiforme; iMRI = intraoperative MRI. obJective The object of this study was to assess the feasibility, accuracy, and safety of real-time MRI-compatible frameless stereotactic brain biopsy. Methods Clinical, imaging, and histological data in consecutive patients who underwent stereotactic brain biopsy using a frameless real-time MRI system were analyzed. results Five consecutive patients (4 males, 1 female) were included in this study. The mean age at biopsy was 45.8 years (range 29-60 years). Real-time MRI permitted concurrent display of the biopsy cannula trajectory and tip during placement at the target. The mean target depth of biopsied lesions was 71.3 mm (range 60.4-80.4 mm). Targeting accuracy analysis revealed a mean radial error of 1.3 ± 1.1 mm (mean ± standard deviation), mean depth error of 0.7 ± 0.3 mm, and a mean absolute tip error of 1.5 ± 1.1 mm. There was no correlation between target depth and absolute tip error (Pearson product-moment correlation coefficient, r = 0.22). All biopsy cannulae were placed at the target with a single penetration and resulted in a diagnostic specimen in all cases. Histopathological evaluation of biopsy samples revealed dysembryoplastic neuroepithelial tumor (1 case),...

Neuroendoscopy Adapter Module Development for Better Brain Tumor Image Visualization

“…NAM algorithm is interesting as it helps to focus on segmentation approach with the focus on tumor edge correctness visibility. Third, unlike previous works [16][17][18], our proposed system doesn't need manually-determined or established regions of interests. Also, our automated detection system is fast and provides high accuracy; unlike the MRI technique which is used in the image classification process that generates real-time pseudographics.…”

“…Also, as per Mohyeldin, Ahmed, et al (2016), the object of their study was to assess the feasibility, accuracy, and safety of real-time MRI-compatible frameless stereotactic brain biopsy. The ability to place a biopsy cannula under real-time imaging guidance permits on-the-fly alterations in the cannula trajectory and tip placement.…”

“…Magnetic resonance imaging underestimates histologically identified tumor boundaries, particularly for wounds that have a high imaging suspicions score and a high Gleason score [16]. A 9 mm treatment perimeter all around a lesion visible on magnetic resonance imaging would certainly consistently make positive treatment method of the entire histological tumor volume during focal ablative therapy.…”

The diagnostic quality of needle brain biopsy specimens obtained with different sampling methods – Experimental study

“…Non-diagnostic samples in brain tumour biopsies are reported in up to 24% of cases and diagnostic errors in 10-30% of cases [2][3][4]9 . Various techniques are employed to improve the diagnostic value of brain biopsy methods [10][11][12][13][14][15][16][17][18] .…”

“…Targeting accuracy in brain biopsies is an important concern, but tissue sample quality for the pathological examination is equally significant. Modern imaging based on magnetic resonance fused with proton emission tomography sometimes provides good coordinates for high accuracy stereotactic and robot-assisted aiming devices, which substantially reduce the risk of missing pathological areas 14,16,17,19 .…”