Intraoperative MR Imaging Guidance for Intracranial Neurosurgery: Experience with the First 200 Cases

Schwartz, Richard B.; Hsu, Liangge; Wong, Terence Z.; Kacher, Daniel F.; Zamani, Amir A.; Black, Peter M.; Alexander, Eben; Stieg, Philip E.; Moriarty, Thomas; Martin, Claudia; Kikinis, Ron; Jólesz, Ferenc A.

doi:10.1148/radiology.211.2.r99ma26477

Cited by 161 publications

(68 citation statements)

References 27 publications

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“…[3][4][5][6][7] Significant data assessing the value of the procedure in terms of completeness of brain tumor resection have been published in the past decade. [8][9][10] At present, the most common design in use is that of an independent but standard MR system fully included in a magnet-safe OR. In a few institutions, like the hospitals of the Minneapolis-Saint Paul, Minn area, the field strength of the B0 is now reaching 3T.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative 3T MR Imaging for Spinal Cord Tumor Resection: Feasibility, Timing, and Image Quality Using a “Twin” MR–Operating Room Suite

Duprez¹,

Jankovski²,

Grandin³

et al. 2008

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] The usefulness of cerebral IoMRI has been assessed in large patient series. [8][9][10] Up to now, spinal cord IoMRI has not been reported yet.…”

mentioning

confidence: 99%

Intraoperative 3T MR Imaging for Spinal Cord Tumor Resection: Feasibility, Timing, and Image Quality Using a “Twin” MR–Operating Room Suite

Duprez¹,

Jankovski²,

Grandin³

et al. 2008

AJNR Am J Neuroradiol

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“…These methods include touch frozen section analysis (25), touch preparation cytology (26), specimen radiography (27,28), rf spectroscopy (29,30), Raman spectroscopy (31), radioguided occult lesion localization (32), near-IR fluorescence (33,34), and high-frequency ultrasound (35)(36)(37). The intraoperative application of MRI, which has been successfully applied in brain surgery (38)(39)(40)(41)(42), is limited in its application in BCS. These limitations include MRI interpretation in the presence of acute surgical changes; lack of real-time imaging, requiring the interruption of surgery; and accurate localization of tumor based on images requiring development of fiducials (43)(44)(45)(46).…”

mentioning

confidence: 99%

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Calligaris

Caragacianu

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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216

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Distinguishing tumor from normal glandular breast tissue is an important step in breast-conserving surgery. Because this distinction can be challenging in the operative setting, up to 40% of patients require an additional operation when traditional approaches are used.Here, we present a proof-of-concept study to determine the feasibility of using desorption electrospray ionization mass spectrometry imaging (DESI-MSI) for identifying and differentiating tumor from normal breast tissue. We show that tumor margins can be identified using the spatial distributions and varying intensities of different lipids. Several fatty acids, including oleic acid, were more abundant in the cancerous tissue than in normal tissues. The cancer margins delineated by the molecular images from DESI-MSI were consistent with those margins obtained from histological staining. Our findings prove the feasibility of classifying cancerous and normal breast tissues using ambient ionization MSI. The results suggest that an MSbased method could be developed for the rapid intraoperative detection of residual cancer tissue during breast-conserving surgery.B reast cancer is the most commonly diagnosed carcinoma in women in the United States and Western countries. Breast conservation surgery (BCS) has become the preferred treatment option for many women with early-stage breast cancer (1). BCS entails resection of the tumor, with a clean margin of normal tissue around it. Surgery is usually followed by radiation therapy. Results from seven large randomized prospective studies, with the largest two having over 20 y of follow-up, have shown equal survival when comparing BCS coupled with whole-breast radiation and mastectomy (2, 3).Normally, breast surgeons aim to remove a patient's tumor, along with a rim of normal tissue that is free of cancer. Preoperative mammography, ultrasonography, or MRI may be used by the surgeon to guide adequate resection (4-6). Despite numerous improvements in imaging and surgical technique, the need for reexcision to achieve complete tumor resection in the United States typically ranges from 20-40% (7-15), and has been reported as being as high as 60% (16). The importance of reexcision is underscored by numerous studies, which have shown that incomplete resection of tumor and positive margins are associated with increased locoregional recurrence compared with negative margins (12,(17)(18)(19)(20). Furthermore, the landmark meta-analysis performed by the Early Breast Cancer Trialists' Collaborative Group (18, 21) directly linked local recurrence to survival, placing great emphasis on the surgeon's role in minimizing local recurrence by obtaining adequate margins.Breast tumor reexcisions are accompanied by a number of undesirable problems: The completion of therapy is delayed, infection rates are increased, cost is increased, there can be a negative psychological impact on the patient, and there can be diminished aesthetic outcomes (22-24). The development of an intraoperative technique that allows the fast and accurate ident...

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“…The use of iMRI has increased in recent years, because it has been shown to increase the percentage of the complete tumor resection compared with surgeries without iMRI. 7,29,[32][33][34] Furthermore, it would be very helpful to fix an optimal time frame for the postoperative MRI. Our data suggest that reactive enhancement after surgery varies greatly in terms of time and appearance, although the surgical procedure was standardized irrespective of the use of iMRI.…”

Section: Discussionmentioning

confidence: 99%

Time window for postoperative reactive enhancement after resection of brain tumors: less than 72 hours

Lescher

Schniewindt

Jurcoane

et al. 2014

FOC

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Object Early postoperative MRI within 72 hours after brain tumor surgery is commonly used to assess residual contrast-enhancing tumor. The 72-hour window is commonly accepted because previous 1.5-T MRI studies have not found confounding postoperative reactive contrast enhancement in this time frame. The sensitivity to detect contrast enhancement increases with the field strengths. Therefore, the authors aimed to assess whether the 72-hour window is also appropriate for the MRI scanner with a field strength of 3 T. Methods The authors retrospectively analyzed findings on early postsurgical MR images acquired in 46 patients treated for high-grade gliomas. They performed 3-T MRI within 7 days before surgery and within 72 hours thereafter. The appearance of enhancement was categorized as postoperative reactive enhancement or tumoral enhancement by comparison with the pattern and location of presurgical enhancing tumor. Results Postoperative reactive enhancement was present in 15 patients (32.6%). This enhancement, not seen on presurgical MRI, had a marginal or leptomeningeal/dural pattern. In 13 patients (28.3%) postsurgical enhancement was found within the first 72 postoperative hours, with the earliest seen 22:57 hours after surgery. Subsequent MR scans in patients with postoperative reactive enhancement did not reveal tumor recurrence in these regions. Conclusions Postoperative reactive enhancement earlier than 72 hours after brain tumor surgery can be expected in about one-third of the cases in which a 3-T scanner is used. This might be due to the higher enhancement-to-brain contrast at higher field strengths. Therefore, the time window of 72 hours does not prevent reactive enhancement, which, however, can be recognized as such comparing it with presurgical enhancing tumor.

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Intraoperative MR Imaging Guidance for Intracranial Neurosurgery: Experience with the First 200 Cases

Cited by 161 publications

References 27 publications

Intraoperative 3T MR Imaging for Spinal Cord Tumor Resection: Feasibility, Timing, and Image Quality Using a “Twin” MR–Operating Room Suite

Intraoperative 3T MR Imaging for Spinal Cord Tumor Resection: Feasibility, Timing, and Image Quality Using a “Twin” MR–Operating Room Suite

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Time window for postoperative reactive enhancement after resection of brain tumors: less than 72 hours

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