3 Tesla intraoperative MRI for brain tumor surgery
Corresponding Author
Daniel Thomas Ginat MD, MS
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Address reprint requests to: D.T.G., 55 Fruit Street, Boston, MA 02114. E-mail: [email protected]Search for more papers by this authorBrooke Swearingen MD
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorWilliam Curry MD
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorDaniel Cahill MD
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorJoseph Madsen MD
Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorPamela W. Schaefer MD
Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorCorresponding Author
Daniel Thomas Ginat MD, MS
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Address reprint requests to: D.T.G., 55 Fruit Street, Boston, MA 02114. E-mail: [email protected]Search for more papers by this authorBrooke Swearingen MD
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorWilliam Curry MD
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorDaniel Cahill MD
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorJoseph Madsen MD
Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorPamela W. Schaefer MD
Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorAbstract
Implementation of intraoperative magnetic resonance imaging (iMRI) has been shown to optimize the extent of resection and safety of brain tumor surgery. In addition, iMRI can help account for the phenomenon of brain shift and can help to detect complications earlier than routine postoperative imaging, which can potentially improve patient outcome. The higher signal-to-noise ratio offered by 3 Tesla (T) iMRI compared with lower field strength systems is particularly advantageous. The purpose of this article is to review the imaging protocols, imaging findings, and technical considerations related to 3T iMRI. To maximize efficiency, iMRI sequences can be tailored to particular types of tumors and procedures, including nonenhancing brain tumor surgery, enhancing brain tumor surgery, transsphenoidal pituitary tumor surgery, and laser ablation. Unique imaging findings on iMRI include the presence of surgically induced enhancement, which can be a potential confounder for residual enhancing tumor, and hyperacute hemorrhage, which tends to have intermediate signal on T1-weighted sequences and high signal on T2-weighted sequences due to the presence of oxyhemoglobin. MR compatibility and radiofrequency shielding pose particularly stringent technical constraints at 3T and influence the design and usage of the surgical suite with iMRI. J. Magn. Reson. Imaging 2014;39:1357–1365. © 2013 Wiley Periodicals, Inc.
REFERENCES
- 1
Berger MS,
Deliganis AV,
Dobbins J,
Keles GE. The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 1994; 74: 1784–1791.
10.1002/1097-0142(19940915)74:6<1784::AID-CNCR2820740622>3.0.CO;2-D CAS PubMed Web of Science® Google Scholar
- 2 Lacroix M, Abi-Said D, Fourney DR, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001; 95: 190–198.
- 3 Pignatti F, van den-Bent M, Curran D, et al. Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 2002; 20: 2076–2084.
- 4 Keles GE, Lamborn KR, Berger MS. Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 2001; 95: 735–745.
- 5
Laws ER,
Shaffrey ME,
Morris A,
Anderson FA Jr. Surgical management of intracranial gliomas--does radical resection improve outcome? Acta Neurochir 2003; 85: S47–S53.
10.1007/978-3-7091-6043-5_7 Google Scholar
- 6 Albert FK, Forsting M, Sartor K, Adams HP, Kunze S. Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 1994; 34: 45–60; discussion 60–61.
- 7 Stummer W, Reulen HJ, Meinel T, et al. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 2008; 62: 564–576.
- 8 Kuhnt D, Becker A, Ganslandt O, Bauer M, Buchfelder M, Nimsky C. Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance. Neuro Oncol 2011; 13: 1339–1348.
- 9 Lang MJ, Kelly JJ, Sutherland GR. A moveable 3-Tesla intraoperative magnetic resonance imaging system. Neurosurgery 2011; 68: 168–179.
- 10 Bohinski RJ, Warnick RE, Gaskill-Shipley MF, et al. Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery 2001; 49: 1133–1143; discussion 1143–1144.
- 11 Black PM, Alexander E III, Martin C, et al. Craniotomy for tumor treatment in an intraoperative magnetic resonance imaging unit. Neurosurgery 1999; 45: 423–431; discussion 431–433.
- 12 Knauth M, Wirtz CR, Aras N, Sartor K. Low-field interventional MRI in neurosurgery: finding the right dose of contrast medium. Neuroradiology 2001; 43: 254–258.
- 13 Nimsky C, Ganslandt O, Buchfelder M, Fahlbusch R. Intraoperative visualization for resection of gliomas: the role of functional neuronavigation and intraoperative 1.5 T MRI. Neurol Res 2006; 28: 482–487.
- 14 Schneider JP, Trantakis C, Rubach M, et al. Intraoperative MRI to guide the resection of primary supratentorial glioblastoma multiforme--a quantitative radiological analysis. Neuroradiology 2005; 47: 489–500.
- 15 Schwartz TH, Stieg PE, Anand VK. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery 2006; 58(Suppl): ONS44–ONS51.
- 16 Bellut D, Hlavica M, Schmid C, Bernays RL. Intraoperative magnetic resonance imaging-assisted transsphenoidal pituitary surgery in patients with acromegaly. Neurosurg Focus 2010; 29: E9.
- 17
Netuka D,
Masopust V,
Belsan T,
Kramar F,
Benes V. One year experience with 3.0 T intraoperative MRI in pituitary surgery. Acta Neurochir Suppl 2011; 109: 157–159.
10.1007/978-3-211-99651-5_24 Google Scholar
- 18 Szerlip NJ, Zhang YC, Placantonakis DG, et al. Transsphenoidal resection of sellar tumors using high-field intraoperative magnetic resonance imaging. Skull Base 2011; 21: 223–232.
- 19 Kim EH, Oh MC, Kim SH. Application of low-field intraoperative magnetic resonance imaging in transsphenoidal surgery for pituitary adenomas: technical points to improve the visibility of the tumor resection margin. Acta Neurochir (Wien) 2013; 155: 485–493.
- 20 Berkmann S, Fandino J, Zosso S, Killer HE, Remonda L, Landolt H. Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions. J Neurosurg 2011; 115: 518–527.
- 21 Nabavi A, Black PM, Gering DT, et al. Serial intraoperative magnetic resonance imaging of brain shift. Neurosurgery 2001; 48: 787–797; discussion 797–798.
- 22 Nimsky C, Ganslandt O, Hastreiter P, et al. Intraoperative diffusion-tensor MR imaging: shifting of white matter tracts during neurosurgical procedures—initial experience. Radiology 2005; 234: 218–225.
- 23 Schwartz RB, Hsu L, Wong TZ, et al. Intraoperative MR imaging guidance for intracranial neurosurgery: experience with the first 200 cases. Radiology 1999; 211: 477–488.
- 24 Hall WA, Galicich W, Bergman T, Truwit CL. 3-Tesla intraoperative MR imaging for neurosurgery. J Neurooncol 2006; 77: 297–303.
- 25 Jankovski A, Francotte F, Vaz G, et al. Intraoperative magnetic resonance imaging at 3-T using a dual independent operating room-magnetic resonance imaging suite: development, feasibility, safety, and preliminary experience. Neurosurgery 2008; 63: 412–424; discussion 424–426.
- 26 Pamir MN, Ozduman K. 3-T ultrahigh-field intraoperative MRI for low-grade glioma resection. Expert Rev Anticancer Ther 2009; 9: 1537–1539.
- 27 Senft C, Seifert V, Hermann E, Franz K, Gasser T. Usefulness of intraoperative ultra low-field magnetic resonance imaging in glioma surgery. Neurosurgery 2008; 63: 257–266; discussion 266–267.
- 28 Lang MJ, Greer AD, Sutherland GR. Intra-operative MRI at 3.0 Tesla: a moveable magnet. Acta Neurochir Suppl 2011; 109: 151–156.
- 29 Pamir MN, Ozduman K, Dincer A, Yildiz E, Peker S, Ozek MM. First intraoperative, shared-resource, ultrahigh-field 3-Tesla magnetic resonance imaging system and its application in low-grade glioma resection. J Neurosurg 2010; 112: 57–69.
- 30 Claus EB, Horlacher A, Hsu L, et al. Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 2005; 103: 1227–1233.
- 31 Chernov MF, Kubo O, Hayashi M, et al. Proton MRS of the peritumoral brain. J Neurol Sci 2005; 228: 137–142.
- 32
Mamata Y,
Mamata H,
Nabavi A, et al. Intraoperative diffusion imaging on a 0.5 Tesla interventional scanner. J Magn Reson Imaging 2001; 13: 115–119.
10.1002/1522-2586(200101)13:1<115::AID-JMRI1017>3.0.CO;2-X CAS PubMed Web of Science® Google Scholar
- 33 Hatiboglu MA, Weinberg JS, Suki D, et al. Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery: a prospective volumetric analysis. Neurosurgery 2009; 64: 1073–1081; discussion 1081.
- 34 Knauth M, Aras N, Wirtz CR, Dorfler A, Engelhorn T, Sartor K. Surgically induced intracranial contrast enhancement: potential source of diagnostic error in intraoperative MR imaging. AJNR Am J Neuroradiol 1999; 20: 1547–1553.
- 35 Torres-Reveron J, Tomasiewicz HC, Shetty A, Amankulor NM, Chiang VL. Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery. J Neurooncol 2013; 113: 495–503.
- 36 Jethwa PR, Barrese JC, Gowda A, Shetty A, Danish SF. Magnetic resonance thermometry-guided laser-induced thermal therapy for intracranial neoplasms: initial experience. Neurosurgery 2012; 71: 133–144; 144–145.
- 37 Jethwa PR, Lee JH, Assina R, Keller IA, Danish SF. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance-guided laser-induced thermal therapy. Neurosurg Pediatr 2011; 8: 468–475.
- 38 Kickhefel A, Roland J, Weiss C, Schick F. Accuracy of real-time MR temperature mapping in the brain: a comparison of fast sequences. Phys Med 2010; 26: 192–201.
- 39 Kahn T, Harth T, Kiwit JC, Schwarzmaier HJ, Wald C, Modder U. In vivo MRI thermometry using a phase-sensitive sequence: preliminary experience during MRI-guided laser-induced interstitial thermotherapy of brain tumors. J Magn Reson Imaging 1998; 8: 160–164.
- 40 Bankson JA, Stafford RJ, Hazle JD. Partially parallel imaging with phase-sensitive data: increased temporal resolution for magnetic resonance temperature imaging. Magn Reson Med 2005; 53: 658–665.
- 41 Anzai Y, Lufkin R, DeSalles A, Hamilton DR, Farahani K, Black KL. Preliminary experience with MR-guided thermal ablation of brain tumors. AJNR Am J Neuroradiol 1995; 16: 39–48.
- 42 Huston OO, Watson RE, Bernstein MA, et al. Intraoperative magnetic resonance imaging findings during deep brain stimulation surgery. J Neurosurg 2011; 115: 852–857.
- 43 Linfante I, Llinas RH, Caplan LR, Warach S. MRI features of intracerebral hemorrhage within 2 hours from symptom onset. Sroke 1999; 30: 2263–2267.
- 44 Spiller M, Tenner MS, Couldwell WT. Effect of absorbable topical hemostatic agents on the relaxation time of blood: an in vitro study with implications for postoperative magnetic resonance imaging. J Neurosurg 2001; 95: 687–693.
- 45 Satyarthee GD, Mahapatra AK. Tension pneumocephalus following transsphenoid surgery for pituitary adenoma - report of two cases. J Clin Neurosci 2003; 10: 495–497.
- 46 Rawal RB, Kimple AJ, Dugar DR, Zanation AM. Minimizing morbidity in endoscopic pituitary surgery: outcomes of the novel nasoseptal rescue flap technique. Otolaryngol Head Neck Surg 2012; 147: 434–437.
- 47 Jankovski A, Francotte F, Vaz G, et al. Intraoperative magnetic resonance imaging at 3-T using a dual independent operating room-magnetic resonance imaging suite: development, feasibility, safety, and preliminary experience. Neurosurgery 2008; 63: 412–424; discussion 424–426.
- 48 Kettenbach J, Kacher DF, Kanan AR, et al. Intraoperative and interventional MRI: recommendations for a safe environment. Minim Invasive Ther Allied Technol 2006; 15: 53–64.
- 49 Pusey E, Lufkin RB, Brown RK, et al. Magnetic resonance imaging artifacts: mechanism and clinical significance. Radiographics 1986; 6: 891–911.
- 50 Colen RR, Kekhia H, Jolesz FA. Multimodality intraoperative MRI for brain tumor surgery. Expert Rev Neurother 2010; 10: 1545–1558.
