Magnetic resonance imaging in neurosurgery

A comparison between preoperative magnetic resonance and intraoperative ultrasound tumor volumes and margins

A major obstacle in surgical neuro-oncology is differentiating the interface between tumor and normal brain. Twenty-two brain tumors were evaluated preoperatively with magnetic resonance imaging. Intraoperative ultrasonography was used to guide surgical resection of these tumors, and results were compared with surgical and pathologic findings. Ultrasound tumor volume estimates were larger than T1 gadolinium-enhanced and T1 non-gadolinium-enhanced volumes, but these differences did not reach statistical significance. Similarly T2 volumes were larger than the corresponding sonographic volumes, except for the subset of low-grade gliomas, and in that instance the difference was small, but again the differences were not statistically significant. Ultrasonography enhanced identification of infiltrating tumor cells beyond falsely underestimated tumor margins as defined by T1 images. Ultrasound images helped differentiate edema as seen on T2 images from solid tumor and normal brain. The information gained from ultrasound images can be used to enhance tumor resection and improve patient survival and quality of life.

Artificial intelligence in the prediction of operative findings in low back surgery

In a prospective trial of 150 patients undergoing first time low back surgery for sciatica, the performance of a computer was compared to that of clinicians in predicting the likely operative findings. The results indicate that artificial intelligence techniques implemented on a computer can be used for predicting operative findings in low back surgery, can out-perform clinicians and can be used to develop better methods of human prediction.