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Li Z, Wang D, Ooi MB, Choudhary P, Ragunathan S, Karis JP, Pipe JG, Quarles CC, Stokes AM. A 3D dual-echo spiral sequence for simultaneous dynamic susceptibility contrast and dynamic contrast-enhanced MRI with single bolus injection. Magn Reson Med 2024; 92:631-644. [PMID: 38469930 DOI: 10.1002/mrm.30077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Perfusion MRI reveals important tumor physiological and pathophysiologic information, making it a critical component in managing brain tumor patients. This study aimed to develop a dual-echo 3D spiral technique with a single-bolus scheme to simultaneously acquire both dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) data and overcome the limitations of current EPI-based techniques. METHODS A 3D spiral-based technique with dual-echo acquisition was implemented and optimized on a 3T MRI scanner with a spiral staircase trajectory and through-plane SENSE acceleration for improved speed and image quality, in-plane variable-density undersampling combined with a sliding-window acquisition and reconstruction approach for increased speed, and an advanced iterative deblurring algorithm. Four volunteers were scanned and compared with the standard of care (SOC) single-echo EPI and a dual-echo EPI technique. Two patients were scanned with the spiral technique during a preload bolus and compared with the SOC single-echo EPI collected during the second bolus injection. RESULTS Volunteer data demonstrated that the spiral technique achieved high image quality, reduced geometric artifacts, and high temporal SNR compared with both single-echo and dual-echo EPI. Patient perfusion data showed that the spiral acquisition achieved accurate DSC quantification comparable to SOC single-echo dual-dose EPI, with the additional DCE information. CONCLUSION A 3D dual-echo spiral technique was developed to simultaneously acquire both DSC and DCE data in a single-bolus injection with reduced contrast use. Preliminary volunteer and patient data demonstrated increased temporal SNR, reduced geometric artifacts, and accurate perfusion quantification, suggesting a competitive alternative to SOC-EPI techniques for brain perfusion MRI.
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Affiliation(s)
- Zhiqiang Li
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Dinghui Wang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Poonam Choudhary
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Sudarshan Ragunathan
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - John P Karis
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - James G Pipe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - C Chad Quarles
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashley M Stokes
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
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2
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Begley SL, McBriar JD, Pelcher I, Schulder M. Intraoperative MRI: A Review of Applications Across Neurosurgical Specialties. Neurosurgery 2024:00006123-990000000-01101. [PMID: 38530004 DOI: 10.1227/neu.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
Intraoperative MRI (iMRI) made its debut to great fanfare in the mid-1990s. However, the enthusiasm for this technology with seemingly obvious benefits for neurosurgeons has waned. We review the benefits and utility of iMRI across the field of neurosurgery and present an overview of the evidence for iMRI for multiple neurosurgical disciplines: tumor, skull base, vascular, pediatric, functional, and spine. Publications on iMRI have steadily increased since 1996, plateauing with approximately 52 publications per year since 2011. Tumor surgery, especially glioma surgery, has the most evidence for the use of iMRI contributing more than 50% of all iMRI publications, with increased rates of gross total resection in both adults and children, providing a potential survival benefit. Across multiple neurosurgical disciplines, the ability to use a multitude of unique sequences (diffusion tract imaging, diffusion-weighted imaging, magnetic resonance angiography, blood oxygenation level-dependent) allows for specialization of imaging for various types of surgery. Generally, iMRI allows for consideration of anatomic changes and real-time feedback on surgical outcomes such as extent of resection and instrument (screw, lead, electrode) placement. However, implementation of iMRI is limited by cost and feasibility, including the need for installation, shielding, and compatible tools. Evidence for iMRI use varies greatly by specialty, with the most evidence for tumor, vascular, and pediatric neurosurgery. The benefits of real-time anatomic imaging, a lack of radiation, and evaluation of surgical outcomes are limited by the cost and difficulty of iMRI integration. Nonetheless, the ability to ensure patients are provided by a maximal yet safe treatment that specifically accounts for their own anatomy and highlights why iMRI is a valuable and underutilized tool across multiple neurosurgical subspecialties.
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Affiliation(s)
- Sabrina L Begley
- Department of Neurosurgery, Brain Tumor Center, Lake Success, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Joshua D McBriar
- Department of Neurosurgery, Brain Tumor Center, Lake Success, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Isabelle Pelcher
- Department of Neurosurgery, Brain Tumor Center, Lake Success, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Michael Schulder
- Department of Neurosurgery, Brain Tumor Center, Lake Success, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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3
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Dmitriev AY, Dashyan VG. [Intraoperative magnetic resonance imaging in surgery of brain gliomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:121-127. [PMID: 35170285 DOI: 10.17116/neiro202286011121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intraoperative magnetic resonance imaging (iMRI) is used in surgery of supratentorial gliomas to assess resection quality, as well as in neoplasm biopsy to control the needle position. Scanners coupled with operating table ensure fast intraoperative imaging, but they require the use of non-magnetic surgical tools. Surgery outside the scanner 5G line allows working with conventional instruments, but patient transportation takes time. Portable iMRI systems do not interfere with surgical workflow but these scanners have poor resolution. Positioning of MRI scanners in adjacent rooms allows imaging simultaneously for several surgeries. Low-field MRI scanners are effective for control of contrast-enhanced glioma resection quality. However, these scanners are less useful in demarcation of residual low-grade tumors. High-field MRI scanners have no similar disadvantage. These scanners ensure fast detection of residual gliomas of all types and functional imaging. Artifacts during iMRI are usually a result of iatrogenic traumatic brain injury and contrast agent leakage. Ways of their prevention are discussed in the review.
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Affiliation(s)
- A Yu Dmitriev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V G Dashyan
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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4
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Roder C, Haas P, Tatagiba M, Ernemann U, Bender B. Technical limitations and pitfalls of diffusion-weighted imaging in intraoperative high-field MRI. Neurosurg Rev 2019; 44:327-334. [PMID: 31732818 DOI: 10.1007/s10143-019-01206-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Image quality in high-field intraoperative MRI (iMRI) is often influenced negatively by susceptibility artifacts. While routine sequences are rather robust, advanced imaging such as diffusion-weighted imaging (DWI) is very sensitive to susceptibility resulting in insufficient imaging data. This study aims to analyze intraoperatively acquired DWI to identify the main factors for susceptibility, to compare results with postoperative images and to identify technical aspects for improvement of intraoperative DWI. METHODS 100 patients with intraaxial lesions operated in a high-field iMRI were analyzed retrospectively for the quality of intraoperative DWI in comparison to the postoperative scan. General quality of the MR scan, individual diffusion restrictions, artifacts, and their causes were analyzed. RESULTS Inclusion criteria were met in 78 patients, 124 diffusion restrictions were included in the comparative analysis. PPV and NPV for the detection of DWI changes intraoperatively were 0.94 and 0.56, respectively (SEN 0.94; SPE 0.56). Image quality was rated significantly (p < 0.0001) worse intraoperatively compared to the postoperative MRI. The main reasons for reduced image quality intraoperatively were air (64%) and artificial material (e.g., compress) (38%) in the resection cavity, as well as positioning of patient's head outside the MR's isocenter 37%. Analysis of surgical approaches showed that frontal craniotomies have the highest risk of limited image quality (40%), whereat better results (15% limited image quality) were seen for all other approaches (p = 0.059). CONCLUSION Intraoperative DWI showed reliable results in this analysis. However, image-quality was limited severely in many cases leading to uncertainty in the interpretation. Susceptibility-causing factors might be prevented in many cases, if the surgical team is aware of them. The most important factors are good filling of the resection cavity with irrigation fluid, not placing artificial materials in the resection cavity and adequate positioning of patient's head according to the MR isocenter.
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Affiliation(s)
- Constantin Roder
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany
| | - Patrick Haas
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany.
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
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Coburger J, Wirtz CR. Fluorescence guided surgery by 5-ALA and intraoperative MRI in high grade glioma: a systematic review. J Neurooncol 2018; 141:533-546. [PMID: 30488293 DOI: 10.1007/s11060-018-03052-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Fluorescence guided surgery by 5-aminolevulinic acid (5-ALA) and intraoperative MRI (iMRI) are currently the most important intraoperative imaging techniques in high grade glioma (HGG) surgery. Few comparative studies exist for these techniques. This review aims to systematically compare 5-ALA and iMRI assisted surgery based on the current literature and discuss the potential impact of a combined use of both techniques. METHODS A systematic literature search based on preferred reporting items for systematic reviews and meta-analysis was performed concerning accuracy of tumor detection; extent of resection; neurological deficits (ND); Quality of life (QoL); usability and combined use of both techniques. Original clinical articles on HGG published until March 31st were screened. RESULTS 169 publications were screened, 81 were eligible and 22 were finally included in the review using. Overall, there is evidence that both imaging techniques improve gross total resection rate in non-eloquent lesions. Imaging results do not correlate at the border zone of a HGG. 5-ALA and contrast-enhanced iMRI seem to have a supplementary effect in tumor detection. Overall, both imaging techniques alone or combined do not seem to increase rate of permanent ND or decrease QoL in HGG surgery when used with intraoperative monitoring/mapping. CONCLUSION Based on the currently available literature no superiority of one technique over the other can be found in the most important outcome parameters. Based on the available information a combined use of 5-ALA and iMRI seems very promising to achieve a resection beyond gadolinium-enhancement. However, only low quality of evidence exists for this approach.
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Affiliation(s)
- Jan Coburger
- Department of Neurosurgery, University of Ulm, Campus Günzburg, Ludwig-Heilmeyerstr. 2, 89321, Günzburg, Germany.
| | - Christian Rainer Wirtz
- Department of Neurosurgery, University of Ulm, Campus Günzburg, Ludwig-Heilmeyerstr. 2, 89321, Günzburg, Germany
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6
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Scherer M, Jungk C, Götz M, Kickingereder P, Reuss D, Bendszus M, Maier-Hein K, Unterberg A. Early postoperative delineation of residual tumor after low-grade glioma resection by probabilistic quantification of diffusion-weighted imaging. J Neurosurg 2018; 130:2016-2024. [PMID: 30052158 DOI: 10.3171/2018.2.jns172951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/23/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In WHO grade II low-grade gliomas (LGGs), early postoperative MRI (epMRI) may overestimate residual tumor on FLAIR sequences. Consequently, MRI at 3-6 months follow-up (fuMRI) is used for delineation of residual tumor. This study sought to evaluate if integration of apparent diffusion coefficient (ADC) maps permits an accurate estimation of residual tumor early on epMRI. METHODS From a consecutive cohort, 43 cases with an initial surgery for an LGG, and complete epMRI (< 72 hours after resection) and fuMRI including ADC maps, were retrospectively identified. Residual FLAIR hyperintense tumor was manually segmented on epMRI and corresponding ADC maps were coregistered. Using an expectation maximization algorithm, residual tumor segments were probabilistically clustered into areas of residual tumor, ischemia, or normal white matter (NWM) by fitting a mixture model of superimposed Gaussian curves to the ADC histogram. Tumor volumes from epMRI, clustering, and fuMRI were statistically compared and agreement analysis was performed. RESULTS Mean FLAIR hyperintensity suggesting residual tumor was significantly larger on epMRI compared to fuMRI (19.4 ± 16.5 ml vs 8.4 ± 10.2 ml, p < 0.0001). Probabilistic clustering of corresponding ADC histograms on epMRI identified subsegments that were interpreted as mean residual tumor (7.6 ± 10.2 ml), ischemia (8.1 ± 5.9 ml), and NWM (3.7 ± 4.9 ml). Therefore, mean tumor quantification error between epMRI and fuMRI was significantly reduced (11.0 ± 10.6 ml vs -0.8 ± 3.7 ml, p < 0.0001). Mean clustered tumor volumes on epMRI were no longer significantly different from the fuMRI reference (7.6 ± 10.2 ml vs 8.4 ± 10.2 ml, p = 0.16). Correlation (Pearson r = 0.96, p < 0.0001), concordance correlation coefficient (0.89, 95% confidence interval 0.83), and Bland-Altman analysis suggested strong agreement between both measures after clustering. CONCLUSIONS Probabilistic segmentation of ADC maps facilitates accurate assessment of residual tumor within 72 hours after LGG resection. Multiparametric image analysis detected FLAIR signal alterations attributable to surgical trauma, which led to overestimation of residual LGG on epMRI compared to fuMRI. The prognostic value and clinical impact of this method has to be evaluated in larger case series in the future.
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Affiliation(s)
| | | | - Michael Götz
- 2Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - David Reuss
- 4Neuropathology, Heidelberg University Hospital; and
| | | | - Klaus Maier-Hein
- 2Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
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7
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Pala A, Reske SN, Eberhardt N, Scheuerle A, König R, Schmitz B, Beer AJ, Wirtz CR, Coburger J. Diagnostic accuracy of intraoperative perfusion-weighted MRI and 5-aminolevulinic acid in relation to contrast-enhanced intraoperative MRI and 11C-methionine positron emission tomography in resection of glioblastoma: a prospective study. Neurosurg Rev 2018; 42:471-479. [PMID: 29808321 DOI: 10.1007/s10143-018-0987-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/06/2018] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
Abstract
The aim of our study was to compare depicted pre-, intra-, and postoperative tumor volume of met-PET, perfusion-weighed MRI (PWI), and Gd-DTPA MRI. Further, to assess their sensitivity and specificity in correlation with histopathological specimen. Inclusion criteria of the prospective study were histological confirmed glioblastoma (GB), age > 18, and eligible for gross total resection (GTR). Met-PET was performed before and after surgery. Gd-DTPA MRI and PWI were performed before, during, and after surgery. A combined 5-aminolevulinic acid (5-ALA) and iMRI-guided surgery was performed. Volumetric analysis was evaluated for all imaging modalities except for 5-ALA. A total of 59 navigated biopsies were taken. Sensitivity and specificity were calculated for Gd-DTPA MRI, PWI, met-PET, and 5-ALA according to the histology of specimen. Met-PET depicted significantly larger tumor volume before surgery (p = 0.01) compared to PWI and Gd-DTPI MRI. We found no significant difference in tumor volume between met-PET and PWI after surgery (p = 0.059). Both PWI and met-PET showed significantly larger tumor volume after surgery when compared to Gd-DTPA (p = 0.018 and p = 0.003, respectively). Intraoperative PWI reading was impaired in 33.3% due to artifacts. Met-PET showed the highest sensitivity for detection of GB with 95%. The lowest sensitivity was found with Gd-DTPA MRI (50%), while 5-ALA and intraoperative PWI showed similar results (69 and 67%). Met-Pet is the imaging modality with the highest sensitivity to detect a residual tumor in GB. Intraoperative PWI seems to have a synergistic effect to Gd-DTPA and 5-ALA. However, its value may be limited by artifacts. Both pre- and intraoperative PWI cannot substitute met-PET in tumor detection.
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Affiliation(s)
- Andrej Pala
- Department of Neurosurgery, University of Ulm, Ludwig-Heilmeyerstr. 2, 89312, Günzburg, Germany.
| | - Sven N Reske
- Department of Nuclear Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Nina Eberhardt
- Department of Nuclear Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Angelika Scheuerle
- Department of Neuropathology, University of Ulm, Ludwig-Heilmeyerstr. 2, 89312, Günzburg, Germany
| | - Ralph König
- Department of Neurosurgery, University of Ulm, Ludwig-Heilmeyerstr. 2, 89312, Günzburg, Germany
| | - Bernd Schmitz
- Department of Neuroradiology, University of Ulm, Ludwig-Heilmeyerstr. 2, 89312, Günzburg, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Christian R Wirtz
- Department of Neurosurgery, University of Ulm, Ludwig-Heilmeyerstr. 2, 89312, Günzburg, Germany
| | - Jan Coburger
- Department of Neurosurgery, University of Ulm, Ludwig-Heilmeyerstr. 2, 89312, Günzburg, Germany
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8
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Wang D, Zhu F, Fung KM, Zhu W, Luo Y, Chu WCW, Tong Mok VC, Wu J, Shi L, Ahuja AT, Mao Y. Predicting Cerebral Hyperperfusion Syndrome Following Superficial Temporal Artery to Middle Cerebral Artery Bypass based on Intraoperative Perfusion-Weighted Magnetic Resonance Imaging. Sci Rep 2015; 5:14140. [PMID: 26365751 PMCID: PMC4568478 DOI: 10.1038/srep14140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/19/2015] [Indexed: 11/09/2022] Open
Abstract
Moyamoya disease leads to the formation of stenosis in the cerebrovasculature. A superficial temporal artery to middle cerebral artery (STA-MCA) bypass is an effective treatment for the disease, yet it is usually associated with postoperative cerebral hyperperfusion syndrome (CHS). This study aimed to evaluate cerebral hemodynamic changes immediately after surgery and assess whether a semiquantitative analysis of an intraoperative magnetic resonance perfusion-weighted image (PWI) is useful for predicting postoperative CHS. Fourteen patients who underwent the STA-MCA bypass surgery were included in this study. An atlas-based registration method was employed for studying hemodynamics in different cerebral regions. Pre- versus intraoperative and group-wise comparisons were conducted to evaluate the hemodynamic changes. A postoperative increase in relative cerebral blood flow (CBF) at the terminal MCA territory (P = 0.035) and drop in relative mean-time-transit at the central MCA territory (P = 0.012) were observed in all patients. However, a significant raise in the increasing ratio of relative-CBF at the terminal MCA territory was only found in CHS patients (P = 0.023). The cerebrovascular changes of the patients after revascularization treatment were confirmed. Intraoperative PWI might be helpful in predicting the change in relative-CBF at MCA terminal territory which might indicate a risk of CHS.
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Affiliation(s)
- Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.,Research Center for Medical Image Computing, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.,Department of Biomedical Engineering and Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Fengping Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Ka Ming Fung
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yishan Luo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Vincent Chung Tong Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anil T Ahuja
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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9
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Hu LS, Kelm Z, Korfiatis P, Dueck AC, Elrod C, Ellingson BM, Kaufmann TJ, Eschbacher JM, Karis JP, Smith K, Nakaji P, Brinkman D, Pafundi D, Baxter LC, Erickson BJ. Impact of Software Modeling on the Accuracy of Perfusion MRI in Glioma. AJNR Am J Neuroradiol 2015; 36:2242-9. [PMID: 26359151 DOI: 10.3174/ajnr.a4451] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/30/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Relative cerebral blood volume, as measured by T2*-weighted dynamic susceptibility-weighted contrast-enhanced MRI, represents the most robust and widely used perfusion MR imaging metric in neuro-oncology. Our aim was to determine whether differences in modeling implementation will impact the correction of leakage effects (from blood-brain barrier disruption) and the accuracy of relative CBV calculations as measured on T2*-weighted dynamic susceptibility-weighted contrast-enhanced MR imaging at 3T field strength. MATERIALS AND METHODS This study included 52 patients with glioma undergoing DSC MR imaging. Thirty-six patients underwent both non-preload dose- and preload dose-corrected DSC acquisitions, with 16 patients undergoing preload dose-corrected acquisitions only. For each acquisition, we generated 2 sets of relative CBV metrics by using 2 separate, widely published, FDA-approved commercial software packages: IB Neuro and nordicICE. We calculated 4 relative CBV metrics within tumor volumes: mean relative CBV, mode relative CBV, percentage of voxels with relative CBV > 1.75, and percentage of voxels with relative CBV > 1.0 (fractional tumor burden). We determined Pearson (r) and Spearman (ρ) correlations between non-preload dose- and preload dose-corrected metrics. In a subset of patients with recurrent glioblastoma (n = 25), we determined receiver operating characteristic area under the curve for fractional tumor burden accuracy to predict the tissue diagnosis of tumor recurrence versus posttreatment effect. We also determined correlations between rCBV and microvessel area from stereotactic biopsies (n = 29) in 12 patients. RESULTS With IB Neuro, relative CBV metrics correlated highly between non-preload dose- and preload dose-corrected conditions for fractional tumor burden (r = 0.96, ρ = 0.94), percentage > 1.75 (r = 0.93, ρ = 0.91), mean (r = 0.87, ρ = 0.86), and mode (r = 0.78, ρ = 0.76). These correlations dropped substantially with nordicICE. With fractional tumor burden, IB Neuro was more accurate than nordicICE in diagnosing tumor versus posttreatment effect (area under the curve = 0.85 versus 0.67) (P < .01). The highest relative CBV-microvessel area correlations required preload dose and IB Neuro (r = 0.64, ρ = 0.58, P = .001). CONCLUSIONS Different implementations of perfusion MR imaging software modeling can impact the accuracy of leakage correction, relative CBV calculation, and correlations with histologic benchmarks.
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Affiliation(s)
- L S Hu
- From the Department of Radiology (L.S.H.) Keller Center for Imaging Innovation (L.S.H., C.E., J.P.K., L.C.B.)
| | - Z Kelm
- the Department of Radiology (Z.K., P.K., T.J.K., B.J.E.), Mayo Clinic, Rochester, Minnesota
| | - P Korfiatis
- the Department of Radiology (Z.K., P.K., T.J.K., B.J.E.), Mayo Clinic, Rochester, Minnesota
| | - A C Dueck
- Biostatistics (A.C.D.), Mayo Clinic, Phoenix/Scottsdale, Arizona
| | - C Elrod
- Keller Center for Imaging Innovation (L.S.H., C.E., J.P.K., L.C.B.)
| | - B M Ellingson
- the Department of Radiological Sciences (B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, California
| | - T J Kaufmann
- the Department of Radiology (Z.K., P.K., T.J.K., B.J.E.), Mayo Clinic, Rochester, Minnesota
| | | | - J P Karis
- Keller Center for Imaging Innovation (L.S.H., C.E., J.P.K., L.C.B.) Neuroradiology (J.P.K.)
| | - K Smith
- Neurosurgery (K.S., P.N.), Barrow Neurological Institute, Phoenix, Arizona
| | - P Nakaji
- Neurosurgery (K.S., P.N.), Barrow Neurological Institute, Phoenix, Arizona
| | - D Brinkman
- the Department of Radiation Oncology (D.B., D.P.), Mayo Clinic, Rochester, Minnesota
| | - D Pafundi
- the Department of Radiation Oncology (D.B., D.P.), Mayo Clinic, Rochester, Minnesota
| | - L C Baxter
- Keller Center for Imaging Innovation (L.S.H., C.E., J.P.K., L.C.B.)
| | - B J Erickson
- the Department of Radiology (Z.K., P.K., T.J.K., B.J.E.), Mayo Clinic, Rochester, Minnesota
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10
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Bisdas S, Roder C, Ernemann U, Tatagiba MS. Intraoperative MR Imaging in Neurosurgery. Clin Neuroradiol 2015; 25 Suppl 2:237-44. [PMID: 26259854 DOI: 10.1007/s00062-015-0443-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/17/2015] [Indexed: 12/01/2022]
Abstract
Intraoperative magnetic resonance imaging (iMRI) has dramatically expanded and nowadays presents state-of-the-art technique for image-guided neurosurgery, facilitating critical precision and effective surgical treatment of various brain pathologies. Imaging hardware providing basic imaging sequences as well as advanced MRI can be seamlessly integrated into routine surgical environments, which continuously leads to emerging indications for iMRI-assisted surgery. Besides the obvious intraoperative diagnostic yield, the initial clinical benefits have to be confirmed by future-controlled long-term studies.
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Affiliation(s)
- S Bisdas
- Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - C Roder
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
| | - U Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - M S Tatagiba
- Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
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Surgery for Glioblastoma: Impact of the Combined Use of 5-Aminolevulinic Acid and Intraoperative MRI on Extent of Resection and Survival. PLoS One 2015; 10:e0131872. [PMID: 26115409 PMCID: PMC4482740 DOI: 10.1371/journal.pone.0131872] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/08/2015] [Indexed: 01/01/2023] Open
Abstract
Background There is rising evidence that in glioblastoma(GBM) surgery an increase of extent of resection(EoR) leads to an increase of patient’s survival. Based on histopathological assessments tumor depiction of Gd-DTPA enhancement and 5-aminolevulinic-acid-fluorescence(5-ALA) might be synergistic for intraoperative resection control. Objective To assess impact of additional use of 5-ALA in intraoperative MRI(iMRI) assisted surgery of GBMs on extent of resection(EoR), progression free survival(PFS) and overall survival(OS). Methods We prospectively enrolled 33 patients with GBMs eligible for gross-total-resection(GTR) and performed a combined approach using 5-ALA and iMRI. As a control group, we performed a retrospective matched pair assessment, based on 144 patients with iMRI-assisted surgery. Matching criteria were, MGMT promotor methylation, recurrent surgery, eloquent location, tumor size and age. Only patients with an intended GTR and primary GBMs were included. We calculated Kaplan Mayer estimates to compare OS and PFS using the Log-Rank-Test. We used the T-test to compare volumetric results of EoR and the Chi-Square-Test to compare new permanent neurological deficits(nPND) and general complications between the two groups. Results Median follow up was 31 months. No significant differences between both groups were found concerning the matching criteria. GTR was achieved significantly more often (p <0.010) using 5-ALA&iMRI (100%) compared to iMRI alone(82%). Mean EoR was significantly(p<0.004) higher in 5-ALA&iMRI-group(99.7%) than in iMRI-alone-group(97.4%) Rate of complications did not differ significantly between groups(21% iMRI-group,27%5-ALA&iMRI-group,p<0.518). nPND were found in 6% in both groups. Median PFS (6mo resp.;p<0.309) and median OS(iMRI:17mo;5-ALA&iMRI-group:18mo;p<0.708)) were not significantly different between both groups. Conclusion We found a significant increase of EoR when combining 5-ALA&iMRI compared to use of iMRI alone. Maximizing EoR did not lead to an increase of complications or neurological deficits if used with neurophysiological monitoring in eloquent lesions. No final conclusion can be drawn whether a further increase of EoR benefits patient’s progression free survival and overall survival.
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Hussain T, Savariar EN, Diaz-Perez JA, Messer K, Pu M, Tsien RY, Nguyen QT. Surgical molecular navigation with ratiometric activatable cell penetrating peptide for intraoperative identification and resection of small salivary gland cancers. Head Neck 2015; 38:715-23. [PMID: 25521629 DOI: 10.1002/hed.23946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We evaluated the use of intraoperative fluorescence guidance by enzymatically cleavable ratiometric activatable cell-penetrating peptide (RACPPPLGC(Me)AG) containing Cy5 as a fluorescent donor and Cy7 as a fluorescent acceptor for salivary gland cancer surgery in a mouse model. METHODS Surgical resection of small parotid gland cancers in mice was performed with fluorescence guidance or white light (WL) imaging alone. Tumor identification accuracy, operating time, and tumor-free survival were compared. RESULTS RACPP guidance aided tumor detection (positive histology in 90% [27/30] vs 48% [15/31] for WL; p < .001). An approximate 25% ratiometric signal increase as the threshold to distinguish between tumor and adjacent tissue, yielded >90% detection sensitivity and specificity. Operating time was reduced by 54% (p < .001), and tumor-free survival was increased with RACPP guidance (p = .025). CONCLUSION RACPP provides real-time intraoperative guidance leading to improved survival. Ratiometric signal thresholds can be set according to desired detection accuracy levels for future RACPP applications.
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Affiliation(s)
- Timon Hussain
- Division of Head and Neck Surgery, University of California San Diego, San Diego, California
| | | | - Julio A Diaz-Perez
- Division of Head and Neck Surgery, University of California San Diego, San Diego, California
| | - Karen Messer
- Division of Biostatistics, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Minya Pu
- Division of Biostatistics, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Roger Y Tsien
- Department of Pharmacology, University of California San Diego, San Diego, California.,Howard Hughes Medical Institute, University of California San Diego, San Diego, California
| | - Quyen T Nguyen
- Division of Head and Neck Surgery, University of California San Diego, San Diego, California
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Intraoperative assistive technologies and extent of resection in glioma surgery: a systematic review of prospective controlled studies. Neurosurg Rev 2014; 38:217-26; discussion 226-7. [DOI: 10.1007/s10143-014-0592-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/15/2014] [Accepted: 08/31/2014] [Indexed: 01/16/2023]
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14
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Maximizing the extent of resection and survival benefit of patients in glioblastoma surgery: High-field iMRI versus conventional and 5-ALA-assisted surgery. Eur J Surg Oncol 2014; 40:297-304. [DOI: 10.1016/j.ejso.2013.11.022] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/16/2013] [Accepted: 11/23/2013] [Indexed: 11/19/2022] Open
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Roder C, Skardelly M, Ramina KF, Beschorner R, Honneger J, Nägele T, Tatagiba MS, Ernemann U, Bisdas S. Spectroscopy imaging in intraoperative MR suite: tissue characterization and optimization of tumor resection. Int J Comput Assist Radiol Surg 2013; 9:551-9. [DOI: 10.1007/s11548-013-0952-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
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