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Calvo-Imirizaldu M, Aramendía-Vidaurreta V, Sánchez-Albardíaz C, Vidorreta M, García de Eulate R, Domínguez Echávarri PD, Pfeuffer J, Bejarano Herruzo B, Gonzalez-Quarante LH, Martinez-Simon A, Fernández-Seara MA. Clinical utility of intraoperative arterial spin labeling for resection control in brain tumor surgery at 3 T. NMR IN BIOMEDICINE 2023:e4938. [PMID: 36967637 DOI: 10.1002/nbm.4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Resection control in brain tumor surgery can be achieved in real time with intraoperative MRI (iMRI). Arterial spin labeling (ASL), a technique that measures cerebral blood flow (CBF) non-invasively without the use of intravenous contrast agents, can be performed intraoperatively, providing morpho-physiological information. This study aimed to evaluate the feasibility, image quality and potential to depict residual tumor of a pseudo-continuous ASL (PCASL) sequence at 3 T. Seventeen patients with brain tumors, primary (16) or metastatic (1), undergoing resection surgery with iMRI monitoring, were prospectively recruited (nine men, age 56 ± 16.6 years). A PCASL sequence with long labeling duration (3000 ms) and postlabeling delay (2000 ms) was added to the conventional protocol, which consisted of pre- and postcontrast 3D T1 -weighted (T1w) images, optional 3D-FLAIR, and diffusion. Three observers independently assessed the image quality (four-point scale) of PCASL-derived CBF maps. In those with diagnostic quality (Scores 2-4) they evaluated the presence of residual tumor using the conventional sequences first, and the CBF maps afterwards (three-point scale). Inter-observer agreement for image quality and the presence of residual tumor was assessed using Fleiss kappa statistics. The intraoperative CBF ratio of the surgical margins (i.e., perilesional CBF values normalized to contralateral gray matter CBF) was compared with preoperative CBF ratio within the tumor (Wilcoxon's test). Diagnostic ASL image quality was observed in 94.1% of patients (interobserver Fleiss κ = 0.76). PCASL showed additional foci suggestive of high-grade residual component in three patients, and a hyperperfused area extending outside the enhancing component in one patient. Interobserver agreement was almost perfect in the evaluation of residual tumor with the conventional sequences (Fleiss κ = 0.92) and substantial for PCASL (Fleiss κ = 0.80). No significant differences were found between pre and intraoperative CBF ratios (p = 0.578) in patients with residual tumor (n = 7). iMRI-PCASL perfusion is feasible at 3 T and is useful for the intraoperative assessment of residual tumor, providing in some cases additional information to the conventional sequences.
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Affiliation(s)
| | - Verónica Aramendía-Vidaurreta
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | | | | | | | - Pablo D Domínguez Echávarri
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Josef Pfeuffer
- Application Development, Siemens Healthcare, Erlangen, Germany
| | | | | | - Antonio Martinez-Simon
- Anesthesia and Intensive Care Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - María A Fernández-Seara
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Measurements of Functional Network Connectivity Using Resting State Arterial Spin Labeling During Neurosurgery. World Neurosurg 2021; 157:152-158. [PMID: 34673240 DOI: 10.1016/j.wneu.2021.10.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022]
Abstract
In neurosurgery, an exact delineation of functional areas is of great interest to spare important regions to ensure the best possible outcome for the patient (i.e., maximum removal while maintaining the highest possible quality of life). Preoperative imaging is routinely performed, including the visualization of not only structural but also functional information. During surgery, however, brain shift can occur, leading to an offset between the previously defined and the real position. Real-time imaging during the procedure is therefore desired to obtain this information while performing surgery. In this study 15 patients suffering from glioblastoma multiforme were included. These patients underwent structural and perfusion imaging using arterial spin labeling during the procedure. The latter has been used for gathering information about tumor residual perfusion. However, special postprocessing of this data allows for additional mapping of resting state networks and is intended to be used to gather deeper insights to aid the surgeon in planning the procedure. The data of each patient could be successfully postprocessed and used to map different resting state networks alongside the default mode network. On the basis of this study, it is feasible to use the information obtained from perfusion imaging to visualize not only vascular signal but also functional activation of resting state networks without acquiring any additional data besides the already available information. This may help guide the neurosurgeon in real time to adjust the surgical plan.
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Lindner T, Ahmeti H, Juhasz J, Helle M, Jansen O, Synowitz M, Ulmer S. A comparison of arterial spin labeling and dynamic susceptibility perfusion imaging for resection control in glioblastoma surgery. Oncotarget 2018; 9:18570-18577. [PMID: 29719627 PMCID: PMC5915094 DOI: 10.18632/oncotarget.24970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 03/18/2018] [Indexed: 12/20/2022] Open
Abstract
Resection control using magnetic resonance imaging during neurosurgical interventions increases confidence regarding the extent of tumor removal already during the procedure. In addition to morphological imaging, functional information such as perfusion might become an important marker of the presence and extent of residual tumor mass. The aim of this study was to implement arterial spin labeling (ASL) perfusion imaging as a noninvasive alternative to dynamic susceptibility contrast (DSC) perfusion imaging in patients suffering from intra-axial tumors for resection control already during surgery. The study included 15 patients suffering from glioblastoma multiforme in whom perfusion imaging using DSC and ASL was performed before, during, and after surgery. The data obtained from intraoperative scanning were analyzed by two readers blinded to any clinical information, and the presence of residual tumor mass was evaluated using a ranking scale. Similarity of results was analyzed using the intraclass correlation coefficient and Pearson's correlation coefficient. The results show that intraoperative ASL is as reliable as DSC when performing intraoperative perfusion imaging. According to the results of this study, intraoperative imaging using ASL represents an attractive alternative to contrast agent-based perfusion imaging.
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Affiliation(s)
- Thomas Lindner
- Clinic for Radiology and Neuroradiology, UKSH Kiel, Kiel, Germany
| | | | - Julia Juhasz
- Clinic for Radiology and Neuroradiology, UKSH Kiel, Kiel, Germany
| | | | - Olav Jansen
- Clinic for Radiology and Neuroradiology, UKSH Kiel, Kiel, Germany
| | | | - Stephan Ulmer
- Clinic for Radiology and Neuroradiology, UKSH Kiel, Kiel, Germany
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Huang H, Lu J, Wu J, Ding Z, Chen S, Duan L, Cui J, Chen F, Kang D, Qi L, Qiu W, Lee SW, Qiu S, Shen D, Zang YF, Zhang H. Tumor Tissue Detection using Blood-Oxygen-Level-Dependent Functional MRI based on Independent Component Analysis. Sci Rep 2018; 8:1223. [PMID: 29352123 PMCID: PMC5775317 DOI: 10.1038/s41598-017-18453-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/12/2017] [Indexed: 11/09/2022] Open
Abstract
Accurate delineation of gliomas from the surrounding normal brain areas helps maximize tumor resection and improves outcome. Blood-oxygen-level-dependent (BOLD) functional MRI (fMRI) has been routinely adopted for presurgical mapping of the surrounding functional areas. For completely utilizing such imaging data, here we show the feasibility of using presurgical fMRI for tumor delineation. In particular, we introduce a novel method dedicated to tumor detection based on independent component analysis (ICA) of resting-state fMRI (rs-fMRI) with automatic tumor component identification. Multi-center rs-fMRI data of 32 glioma patients from three centers, plus the additional proof-of-concept data of 28 patients from the fourth center with non-brain musculoskeletal tumors, are fed into individual ICA with different total number of components (TNCs). The best-fitted tumor-related components derived from the optimized TNCs setting are automatically determined based on a new template-matching algorithm. The success rates are 100%, 100% and 93.75% for glioma tissue detection for the three centers, respectively, and 85.19% for musculoskeletal tumor detection. We propose that the high success rate could come from the previously overlooked ability of BOLD rs-fMRI in characterizing the abnormal vascularization, vasomotion and perfusion caused by tumors. Our findings suggest an additional usage of the rs-fMRI for comprehensive presurgical assessment.
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Affiliation(s)
- Huiyuan Huang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
- School of Psychology, South China Normal University, Guangzhou, 510631, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, China
| | - Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Shuda Chen
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Lisha Duan
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Jianling Cui
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Fuyong Chen
- Department of Neurosurgery, No.1 Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Dezhi Kang
- Department of Neurosurgery, No.1 Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Le Qi
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015, China
| | - Wusi Qiu
- Department of Neurosurgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015, China
| | - Seong-Whan Lee
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - ShiJun Qiu
- Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Dinggang Shen
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Republic of Korea.
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, China
| | - Han Zhang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China.
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, China.
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Huang H, Lu J, Wu J, Ding Z, Chen S, Duan L, Cui J, Chen F, Kang D, Qi L, Qiu W, Lee SW, Qiu S, Shen D, Zang YF, Zhang H. Tumor Tissue Detection using Blood-Oxygen-Level-Dependent Functional MRI based on Independent Component Analysis. Sci Rep 2018; 8:1223. [PMID: 29352123 DOI: 10.1038/s41598-017-18453-0.pmid: 29352123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/12/2017] [Indexed: 10/27/2024] Open
Abstract
Accurate delineation of gliomas from the surrounding normal brain areas helps maximize tumor resection and improves outcome. Blood-oxygen-level-dependent (BOLD) functional MRI (fMRI) has been routinely adopted for presurgical mapping of the surrounding functional areas. For completely utilizing such imaging data, here we show the feasibility of using presurgical fMRI for tumor delineation. In particular, we introduce a novel method dedicated to tumor detection based on independent component analysis (ICA) of resting-state fMRI (rs-fMRI) with automatic tumor component identification. Multi-center rs-fMRI data of 32 glioma patients from three centers, plus the additional proof-of-concept data of 28 patients from the fourth center with non-brain musculoskeletal tumors, are fed into individual ICA with different total number of components (TNCs). The best-fitted tumor-related components derived from the optimized TNCs setting are automatically determined based on a new template-matching algorithm. The success rates are 100%, 100% and 93.75% for glioma tissue detection for the three centers, respectively, and 85.19% for musculoskeletal tumor detection. We propose that the high success rate could come from the previously overlooked ability of BOLD rs-fMRI in characterizing the abnormal vascularization, vasomotion and perfusion caused by tumors. Our findings suggest an additional usage of the rs-fMRI for comprehensive presurgical assessment.
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Affiliation(s)
- Huiyuan Huang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
- School of Psychology, South China Normal University, Guangzhou, 510631, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, China
| | - Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Shuda Chen
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China
| | - Lisha Duan
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Jianling Cui
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Fuyong Chen
- Department of Neurosurgery, No.1 Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Dezhi Kang
- Department of Neurosurgery, No.1 Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Le Qi
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015, China
| | - Wusi Qiu
- Department of Neurosurgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015, China
| | - Seong-Whan Lee
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - ShiJun Qiu
- Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Dinggang Shen
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Republic of Korea.
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, China
| | - Han Zhang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, China.
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, China.
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Intraoperative resection control using arterial spin labeling - Proof of concept, reproducibility of data and initial results. NEUROIMAGE-CLINICAL 2017; 15:136-142. [PMID: 28507896 PMCID: PMC5423346 DOI: 10.1016/j.nicl.2017.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/19/2017] [Accepted: 04/21/2017] [Indexed: 11/24/2022]
Abstract
Objectives Intraoperative magnetic resonance imaging is a unique tool for visualizing structures during resection and/or for updating any kind of neuronavigation that might be hampered as a result of brain shift during surgery. Advanced MRI techniques such as perfusion-weighted imaging have already proven to be important in the initial diagnosis preoperatively, but can also help to differentiate between tumor and surgically induced changes intraoperatively. Commonly used methods to visualize brain perfusion include contrast agent administration and are therefore somewhat limited. One method that uses blood as an internal contrast medium is arterial spin labeling (ASL), which might represent an attractive alternative. Materials and methods Ten healthy volunteers were examined using three different scanners and coils within 1 h (3T Achieva MRI using 32-channel head coil, 1.5T Achieva MRI using a 6-channel head coil, 1.5 Intera Scanner using 2 surface coils, Philips, Best, The Netherlands) and quantitative CBF values were calculated and compared between the different setups. Additionally, in eight patients with glioblastoma multiforme, ASL was used pre-, intra-, and postoperatively to define tumor tissue and the extent of resection in comparison to structural imaging. Results A high correlation (r = 0.91–0.96) was found between MRI scanners and coils used. ASL was as reliable as conventional MR imaging if complete resection was already achieved, but additionally provided valuable information regarding residual tumor tissue in one patient. Conclusions Intraoperative arterial spin-labeling is a feasible, reproducible, and reliable tool to map CBF in brain tumors and seems to give beneficial information compared to conventional intraoperative MR imaging in partial resection.
The use of arterial spin labeling intraoperatively during neurosurgical interventions is presented. Reproducibility and comparability using various field strengths were successfully proven in a volunteer cohort. Detection of residual tumor in patients was compared to contrast-enhanced imaging. Residual tumor could be identified with a high accuracy.
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Stadlbauer A, Merkel A, Zimmermann M, Sommer B, Buchfelder M, Meyer-Bäse A, Rössler K. Intraoperative Magnetic Resonance Imaging of Cerebral Oxygen Metabolism During Resection of Brain Lesions. World Neurosurg 2017; 100:388-394. [PMID: 28137548 DOI: 10.1016/j.wneu.2017.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Tissue oxygen tension is an important parameter for brain tissue viability and its noninvasive intraoperative monitoring in the whole brain is of highly clinical relevance. The purpose of this study was the introduction of a multiparametric quantitative blood oxygenation dependent magnetic resonance imaging (MRI) approach for intraoperative examination of oxygen metabolism during the resection of brain lesions. METHODS Sixteen patients suffering from brain lesions were examined intraoperatively twice (before craniotomy and after gross-total resection) via the quantitative blood oxygenation dependent technique and a 1.5-Tesla MRI scanner, which is installed in an operating room. The MRI protocol included T2*- and T2 mapping and dynamic susceptibility weighted perfusion. Data analysis was performed with a custom-made, in-house MatLab software for calculation of maps of oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) as well as of cerebral blood volume and cerebral blood flow. RESULTS Perilesional edema showed a significant increase in both perfusion (cerebral blood volume +21%, cerebral blood flow +13%) and oxygen metabolism (OEF +32%, CMRO2 +16%) after resection of the lesions. In perilesional nonedematous tissue only, however, oxygen metabolism (OEF +19%, CMRO2 +11%) was significantly increased, but not perfusion. No changes were found in normal brain. Fortunately, no neurovascular adverse events were observed. CONCLUSIONS This approach for intraoperative examination of oxygen metabolism in the whole brain is a new application of intraoperative MRI additionally to resection control (residual tumor detection) and updating of neuronavigation (brain shift detection). It may help to detect neurovascular adverse events early during surgery.
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Affiliation(s)
- Andreas Stadlbauer
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany; Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria.
| | - Andreas Merkel
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Max Zimmermann
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Björn Sommer
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Anke Meyer-Bäse
- Department of Scientific Computing, Florida State University, Tallahassee, Florida, USA
| | - Karl Rössler
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Basic Principles and Clinical Applications of Magnetic Resonance Spectroscopy in Neuroradiology. J Comput Assist Tomogr 2016; 40:1-13. [PMID: 26484954 DOI: 10.1097/rct.0000000000000322] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance spectroscopy is a powerful tool to assist daily clinical diagnostics. This review is intended to give an overview on basic principles of the technology, discuss some of its technical aspects, and present typical applications in daily clinical routine in neuroradiology.
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Harris RJ, Cloughesy TF, Hardy AJ, Liau LM, Pope WB, Nghiemphu PL, Lai A, Ellingson BM. MRI perfusion measurements calculated using advanced deconvolution techniques predict survival in recurrent glioblastoma treated with bevacizumab. J Neurooncol 2015; 122:497-505. [DOI: 10.1007/s11060-015-1755-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
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Ulmer S. Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures. World J Radiol 2014; 6:538-543. [PMID: 25170392 PMCID: PMC4147435 DOI: 10.4329/wjr.v6.i8.538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/17/2014] [Accepted: 06/18/2014] [Indexed: 02/06/2023] Open
Abstract
The goal in brain tumor surgery is to remove the maximum achievable amount of the tumor, preventing damage to “eloquent” brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been introduced, including an operating microscope in the late 1950s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resection cavity and thus overcome this remaining uncertainty of intraoperative MRI in high grade brain tumor resection.
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Özduman K, Yıldız E, Dinçer A, Sav A, Pamir MN. Using intraoperative dynamic contrast-enhanced T1-weighted MRI to identify residual tumor in glioblastoma surgery. J Neurosurg 2013; 120:60-6. [PMID: 24138206 DOI: 10.3171/2013.9.jns121924] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECT The goal of surgery in high-grade gliomas is to maximize the resection of contrast-enhancing tumor without causing additional neurological deficits. Intraoperative MRI improves surgical results. However, when using contrast material intraoperatively, it may be difficult to differentiate between surgically induced enhancement and residual tumor. The purpose of this study was to assess the usefulness of intraoperative dynamic contrast-enhanced T1-weighted MRI to guide this differential diagnosis and test it against tissue histopathology. METHODS Preoperative and intraoperative dynamic contrast-enhanced MRI was performed in 21 patients with histopathologically confirmed WHO Grade IV gliomas using intraoperative 3-T MRI. Standardized regions of interest (ROIs) were placed manually at 2 separate contrast-enhancing areas at the resection border for each patient. Time-intensity curves (TICs) were generated for each ROI. All ROIs were biopsied and the TIC types were compared with histopathological results. Pharmacokinetic modeling was performed in the last 10 patients to confirm nonparametric TIC analysis findings. RESULTS Of the 42 manually selected ROIs in 21 patients, 25 (59.5%) contained solid tumor tissue and 17 (40.5%) retained the brain parenchymal architecture but contained infiltrating tumor cells. Time-intensity curves generated from residual contrast-enhancing tumor and their preoperative counterparts were comparable and showed a quick and persistently increasing slope ("climbing type"). All 17 TICs obtained from regions that did not contain solid tumor tissue were undulating and low in amplitude, compared with those obtained from residual tumors ("low-amplitude type"). Pharmacokinetic findings using the transfer constant, extravascular extracellular volume fraction, rate constant, and initial area under the curve parameters were significantly different for the tumor mass, nontumoral regions, and surgically induced contrast-enhancing areas. CONCLUSIONS Intraoperative dynamic contrast-enhanced MRI provides quick, reproducible, high-quality, and simply interpreted dynamic MR images in the intraoperative setting and can aid in differentiating surgically induced enhancement from residual tumor.
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Avula S, Pettorini B, Abernethy L, Pizer B, Williams D, Mallucci C. High field strength magnetic resonance imaging in paediatric brain tumour surgery--its role in prevention of early repeat resections. Childs Nerv Syst 2013; 29:1843-50. [PMID: 23673720 DOI: 10.1007/s00381-013-2106-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study is to compare the surgical and imaging outcome in children who underwent brain tumour surgery with intention of complete tumour resection, prior to and following the start of intra-operative MRI (ioMRI) service. METHODS ioMRI service for brain tumour resection commenced in October 2009. A cohort of patients operated between June 2007 and September 2009 with a pre-surgical intention of complete tumour resection were selected (Group A). A similar number of consecutive cases were selected from a prospective database of patients undergoing ioMRI (Group B). The demographics, imaging, pathology and surgical outcome of both groups were compared. RESULTS Thirty-six of 47 cases from Group A met the inclusion criterion and 36 cases were selected from Group B; 7 of the 36 cases in Group A had unequivocal evidence of residual tumour on the post-operative scan; 5 (14%) of them underwent repeat resection within 6 months post-surgery. In Group B, ioMRI revealed unequivocal evidence of residual tumour in 11 of the 36 cases following initial resection. In 10 of these 11 cases, repeat resections were performed during the same surgical episode and none of these 11 cases required repeat surgery in the following 6 months. Early repeat resection rate was significantly different between both groups (p = 0.003). CONCLUSION Following the advent of ioMRI at our institution, the need for repeat resection within 6 months has been prevented in cases where ioMRI revealed unequivocal evidence of residual tumour.
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Affiliation(s)
- Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK,
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Pamir MN, Özduman K, Yıldız E, Sav A, Dinçer A. Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery: clinical article. J Neurosurg 2013; 118:1191-8. [PMID: 23432196 DOI: 10.3171/2013.1.jns111561] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- M Necmettin Pamir
- Department of Neurosurgery, Acıbadem University School of Medicine, Istanbul, Turkey
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"Awake" intraoperative functional MRI (ai-fMRI) for mapping the eloquent cortex: Is it possible in awake craniotomy? NEUROIMAGE-CLINICAL 2012; 2:132-42. [PMID: 24179766 PMCID: PMC3777788 DOI: 10.1016/j.nicl.2012.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/30/2012] [Accepted: 12/01/2012] [Indexed: 12/04/2022]
Abstract
As a promising noninvasive imaging technique, functional MRI (fMRI) has been extensively adopted as a functional localization procedure for surgical planning. However, the information provided by preoperative fMRI (pre-fMRI) is hampered by the brain deformation that is secondary to surgical procedures. Therefore, intraoperative fMRI (i-fMRI) becomes a potential alternative that can compensate for brain shifts by updating the functional localization information during craniotomy. However, previous i-fMRI studies required that patients be under general anesthesia, preventing the wider application of such a technique as the patients cannot perform tasks unless they are awake. In this study, we propose a new technique that combines awake surgery and i-fMRI, named “awake” i-fMRI (ai-fMRI). We introduced ai-fMRI to the real-time localization of sensorimotor areas during awake craniotomy in seven patients. The results showed that ai-fMRI could successfully detect activations in the bilateral primary sensorimotor areas and supplementary motor areas for all patients, indicating the feasibility of this technique in eloquent area localization. The reliability of ai-fMRI was further validated using intraoperative stimulation mapping (ISM) in two of the seven patients. Comparisons between the pre-fMRI-derived localization result and the ai-fMRI derived result showed that the former was subject to a heavy brain shift and led to incorrect localization, while the latter solved that problem. Additionally, the approaches for the acquisition and processing of the ai-fMRI data were fully illustrated and described. Some practical issues on employing ai-fMRI in awake craniotomy were systemically discussed, and guidelines were provided.
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Enmi JI, Kudomi N, Hayashi T, Yamamoto A, Iguchi S, Moriguchi T, Hori Y, Koshino K, Zeniya T, Jon Shah N, Yamada N, Iida H. Quantitative assessment of regional cerebral blood flow by dynamic susceptibility contrast-enhanced MRI, without the need for arterial blood signals. Phys Med Biol 2012; 57:7873-92. [DOI: 10.1088/0031-9155/57/23/7873] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abernethy LJ, Avula S, Hughes GM, Wright EJ, Mallucci CL. Intra-operative 3-T MRI for paediatric brain tumours: challenges and perspectives. Pediatr Radiol 2012; 42:147-57. [PMID: 22286342 DOI: 10.1007/s00247-011-2280-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 07/13/2011] [Accepted: 08/04/2011] [Indexed: 10/14/2022]
Abstract
MRI is the ideal modality for imaging intracranial tumours. Intraoperative MRI (ioMRI) makes it possible to obtain scans during a neurosurgical operation that can aid complete macroscopic tumour resection—a major prognostic factor in the majority of brain tumours in children. Intraoperative MRI can also help limit damage to normal brain tissue. It therefore has the potential to improve the survival of children with brain tumours and to minimise morbidity, including neurological deficits. The use of ioMRI is also likely to reduce the need for second look surgery, and may reduce the need for chemotherapy and radiotherapy. Highfield MRI systems provide better anatomical information and also enable effective utilisation of advanced MRI techniques such as perfusion imaging, diffusion tensor imaging, and magnetic resonance spectroscopy. However, high-field ioMRI facilities require substantial capital investment, and careful planning is required for optimal benefit. Safe ioMRI requires meticulous attention to detail and rigorous application of magnetic field safety precautions. Interpretation of ioMRI can be challenging and requires experience and understanding of artefacts that are common in the intra-operative setting.
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Affiliation(s)
- L J Abernethy
- Department of Radiology, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
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Sherman JH, Hoes K, Marcus J, Komotar RJ, Brennan CW, Gutin PH. Neurosurgery for Brain Tumors: Update on Recent Technical Advances. Curr Neurol Neurosci Rep 2011; 11:313-9. [DOI: 10.1007/s11910-011-0188-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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