Glioma surgery using a multimodal navigation system with integrated metabolic images

Tanaka, Yoji; Nariai, Tadashi; Momose, Toshiya; Aoyagi, Masaru; Maehara, Taketoshi; Tomori, Toshiki; Yoshino, Yoshikazu; Nagaoka, Tsukasa; Ishiwata, Kiichi; Ishii, Kenji; Ohno, Kikuo

doi:10.3171/2008.4.17569

Cited by 86 publications

(61 citation statements)

References 30 publications

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“…17,19,[25][26][27][28][29][30][31] We attempted to approach this important issue in the present report.…”

Section: Discussionmentioning

confidence: 99%

“…This image-histological comparison will logically support the utility of 11 C-methionine PET image-guided surgery for cytoreduction of gliomas with the possibility of identifying the tumor/nontumor border, although clinical data for PETguided resection is limited at present. 17,30 The second aspect of the present study was to reveal the relationship between 5-ALA-induced fluorescence and histology. The results showed that cell density and Ki-67 labeling index were higher in the fluorescence-positive area than in negative area.…”

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confidence: 99%

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¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

Arita

Kinoshita

Kagawa

et al. 2011

Cancer

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BACKGROUND:The extent of tumor resection is acknowledged as 1 of the prognostic factors for glioma. 5-Aminolevulinic acid (5-ALA)-induced fluorescence guidance and neuronavigation integrated with 11 C-methionine positron emission tomography (PET) are widely utilized under the expectation of improving the extent of resection. These 2 novel approaches are beneficial for glioma resections, and the combination of these approaches appears rational. However, biological characteristics reflecting 5-ALA-induced fluorescence and 11 C-methionine uptake have not been clearly elucidated, and studies about the relationship between 5-ALA-induced fluorescence and 11 C-methionine uptake have been limited. The present study aimed to clarify this issue. METHODS: Data from 11 consecutive patients harboring astrocytic tumors were analyzed: 2 grade II and 2 grade III, and 7 grade IV tumors were included. Thirty samples from these patients were obtained from the relative periphery of each tumor. Relationships among histology, 5-ALA-induced fluorescence and 11 C-methionine uptake were analyzed by stereotactic sampling and image analysis. RESULTS:Uptake of 11 C-methionine correlated with cell density (R 2 ¼ 0.322, P ¼ .0059). Cell density was higher in fluorescence-positive areas than in negative areas (2760 AE 1080 vs 1450 AE 1380/mm 2 , P ¼ .0132). Although both 11 C-methionine uptake and fluorescence seemed to correlate with cell density, no significant difference in 11 C-methionine uptake was seen between fluorescence-positive and -negative areas (P ¼ .367). Multiple linear regression analysis revealed 11 C-methionine uptake and 5-ALA-induced fluorescence as independent indices for tumor cell density. CONCLUSIONS:These results indicate that 5-ALA fluorescence and 11 C-methionine PET image are separate index markers for cytoreduction surgery of gliomas.

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“…17,19,[25][26][27][28][29][30][31] We attempted to approach this important issue in the present report.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

Arita

Kinoshita

Kagawa

et al. 2011

Cancer

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“…For this application, amino acid and nucleoid tracers are better suited (123)(124)(125)(126)(127). Several studies suggested that outcomes are better for patients in whom 11 C-MET or 18 F-FET PET coregistered to MRI are applied for treatment planning and follow-up than for patients diagnosed by MRI alone (123)(124)(125)(126)128). In the follow-up and for the management of patients with brain tumor, the differentiation between recurrent tumor as a sign of treatment failure and necrosis as an indicator of success is essential.…”

Section: Monitoring Treatment Effects Petmentioning

confidence: 99%

Multimodality Assessment of Brain Tumors and Tumor Recurrence

Heiss¹,

Raab²,

Lanfermann³

2011

J Nucl Med

126

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the differences in the information obtained by various MRI and PET modalities and (2) the best combination of imaging procedures to detect brain tumors, to define the biologic activity or malignancy of a tumor, to validate therapeutic effects, and to differentiate between recurrent tumor and tissue necrosis.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through October 2012.Neuroimaging plays a significant role in the diagnosis of intracranial tumors, especially brain gliomas, and must consist of an assessment of location and extent of the tumor and of its biologic activity. Therefore, morphologic imaging modalities and functional, metabolic, or molecular imaging modalities should be combined for primary diagnosis and for following the course and evaluating therapeutic effects. MRI is the gold standard for providing detailed morphologic information and can supply some additional insights into metabolism (MR spectroscopy) and perfusion (perfusion-weighted imaging) but still has limitations in identifying tumor grade, invasive growth into neighboring tissue, and treatment-induced changes, as well as recurrences. These insights can be obtained by various PET modalities, including imaging of glucose metabolism, amino acid uptake, nucleoside uptake, and hypoxia. Diagnostic accuracy can benefit from coregistration of PET results and MRI, combining the high-resolution morphologic images with the biologic information. These procedures are optimized by the newly developed combination of PET and MRI modalities, permitting the simultaneous assessment of morphologic, functional, metabolic, and molecular information on the human brain. Brai n tumors are newly formed alterations of morphology, and for their diagnosis, therefore, CT or MRI is mandatory. These imaging modalities are essential for delineating the normal and pathologic anatomy and also for assessing vascular supply and impairment of the blood-brain barrier (BBB) (perfusion-weighted imaging; contrast enhancement). Additionally, MRI is capable of giving functional information on microstructural (diffusion-weighted imaging [DWI]), physiologic, and metabolic (MR spectroscopy [MRS]) changes of tumor tissues. PET and MRI provide physiologic, biochemical, and molecular information related to tumor metabolism, proliferation rate, invasiveness, and interaction with surrounding and remote areas-informati...

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“…Multi-model fusion imaging technology, as a new tool, has widely been used in neurosurgery recently (18). It can merge the computed tomography (CT) and MRI images together; build 3D framework of brain structure; combine with MRI angiography, CT angiography, DTI, magnetoencephalography, and other functional magnetic resonance imaging; integrate into the navigation system, and complete individualized preoperative plan (23). Functional magnetic resonance imaging confirms the orientation of cortical motor and language area.…”

Section: Casementioning

confidence: 99%

Preoperative visualization of cranial nerves in skull base tumor surgery using diffusion tensor imaging technology

Ma¹,

Su²,

Yue³

et al. 2015

Turkish Neurosurgery

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ABSTRACTdiffusion tensor imaging (DTI) technology (17), it is possible now to identify the major brain white matter fibers. However, it is still difficult to achieve imaging of the small fiber bundles such as CNs. A number of recent researches have attempted to identify CNs using high-resolution or high-density DTI in subjects with or without skull base lesions (7,20). The present study aimed to identify CNs in patients with skull base tumor using DTI technology with special parameters and analyze the technological parameters used. It also involved the evaluation of preoperative estimates and intraoperative confirmation of the relationship between nerves and tumor by verifying the accuracy of visualization. █ INTRODUCTIONA dvances in neuroimaging, intraoperative monitoring, and microsurgical technique have shifted the current focus of skull base surgery from preserving life to preserving cranial nerve function. Preoperative planning using 3-dimensional (3D) visualization of image fusion has become an important development trend in skull base surgery. However, exact visualization and identification of cranial nerves (CNs) is still a challenging task with these imaging techniques due to lack of practical technology support, especially during pathological conditions. Thanks to the rapid development of AIm: To visualize cranial nerves (CNs) using diffusion tensor imaging (DTI) with special parameters. This study also involved the evaluation of preoperative estimates and intraoperative confirmation of the relationship between nerves and tumor by verifying the accuracy of visualization. mATERIAl and mEThODS: 3T magnetic resonance imaging scans including 3D-FSPGR, FIeSTA, and DTI were used to collect information from 18 patients with skull base tumor. DTI data were integrated into the 3D slicer for fiber tracking and overlapped anatomic images to determine course of nerves. 3D reconstruction of tumors was achieved to perform neighboring, encasing, and invading relationship between lesion and nerves. RESUlTS:Optic pathway including the optic chiasm could be traced in cases of tuberculum sellae meningioma and hypophysoma (pituitary tumor). The oculomotor nerve, from the interpeduncular fossa out of the brain stem to supraorbital fissure, was clearly visible in parasellar meningioma cases. Meanwhile, cisternal parts of trigeminal nerve and abducens nerve, facial nerve were also imaged well in vestibular schwannomas and petroclival meningioma cases. The 3D-spatial relationship between CNs and skull base tumor estimated preoperatively by tumor modeling and tractography corresponded to the results determined during surgery. CONClUSION:Supported by DTI and 3D slicer, preoperative 3D reconstruction of most CNs related to skull base tumor is feasible in pathological circumstances. We consider DTI Technology to be a useful tool for predicting the course and location of most CNs, and syntopy between them and skull base tumor.

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Glioma surgery using a multimodal navigation system with integrated metabolic images

Abstract: The authors' preliminary intrainstitutional comparison between the 2 navigation systems suggested the possible premise of multimodal navigation. The multimodal navigation system using MET-PET fusion imaging is an interesting technique that may prove to be valuable in the future.

Cited by 86 publications

References 30 publications

¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

Multimodality Assessment of Brain Tumors and Tumor Recurrence

Preoperative visualization of cranial nerves in skull base tumor surgery using diffusion tensor imaging technology

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Glioma surgery using a multimodal navigation system with integrated metabolic images

Abstract: The authors' preliminary intrainstitutional comparison between the 2 navigation systems suggested the possible premise of multimodal navigation. The multimodal navigation system using MET-PET fusion imaging is an interesting technique that may prove to be valuable in the future.

Cited by 86 publications

References 30 publications

11C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

11C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

Multimodality Assessment of Brain Tumors and Tumor Recurrence

Preoperative visualization of cranial nerves in skull base tumor surgery using diffusion tensor imaging technology

Contact Info

Product

Resources

About

¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma