“Real” three-dimensional constructive interference in steady-state imaging to discern microneurosurgical anatomy

Abstract

Three-dimensional (3D) neuroimages are generally considered useful for neurosurgical practice. Nevertheless, neuroimaging modalities such as 3D digital subtraction angiography and 3D computerized tomography angiography are still insufficient because the resulting images fail to delineate neural structures. Complex neurosurgical procedures are mostly performed in the cerebrospinal fluid (CSF) space of the basal cistern, where vessels and neural structures are present along with the lesion. The magnetic resonance (MR) imaging-derived 3D constructive interference in steady-state (CISS) imaging displays the margin between the CSF and neural structures, vessels, and dura mater in detail, in a two-dimensional fashion. The authors know that volume-rendered 3D CISS images would be more useful for surgery than conventional ones. Although the usefulness of "virtual MR image endoscopy" was reported previously, the endoscopic view is different from the operative field because of the perspective being emphasized. Therefore, to simulate surgical views, the authors made 3D neuroimages from a 3D CISS MR sequence by using an advanced computer workstation. After generating volume images, a cutting method was used in the desired plane to visualize the lesion with reference to a multiplanar reformatted image. The authors call these "real" 3D CISS images, and they are more comparable to the operative field. This newly developed method of producing a real 3D CISS image was used in 30 cases and contributed to the understanding of the relationship between a lesion and surrounding structures before attempting neurosurgical procedures, with minimal invasiveness to the patient.

Compared with the Conventional MR Imaging, Do the Constructive Interference Steady State Sequence and Diffusion Weighted Imaging Aid in the Diagnosis of Lumbar Disc Hernias?

“…CISS sequence: The 3D-steady-state refocused gradientecho sequence is flow-compensated, high-contrast and highspatial resolution with the slice thickness reduced to 0.7 mm, resulting in detailed visualization and differentiation of the various components of the nerve roots, vessels, CSF and the neural structures surrounded by CSF [4,5,10]. Therefore, this sequence has been mostly used in the assessment of cranial nerves to evaluate their pathologies in the cerebellopontine angle and inner ear [5,[10][11][12]. As a short TE and low flip angle is employed, the CISS sequence is amenable to 3D acquisition, high T2/T1 and high CSF/ nerve contrast and accentuated T2 weighting.…”

Is All “Communicating” Hydrocephalus Really Communicating? Prospective Study on the Value of 3D-Constructive Interference in Steady State Sequence at 3T

“…Usefulness of the 3D-CISS images has been shown in detailing the microsurgical anatomy in the brain, which aids surgical planning and approaches, 3,[5][6][7][8]10,11 as well as in evaluation of other neurosurgical pathologic findings such as hypothalamic hamartomas in which high CSF/tissue contrast is required.…”

“…The 3D-CISS sequence was acquired with 0.6 ϫ 0.6 ϫ 0.6-mm 3 isometric voxel allowing reconstruction in any arbitrary plane for optimal visualization. The various sequence parameters are summarized in Table 1.…”

“…During the past decade, 3D-CISS sequence has been introduced and used in the assessment of normal and pathologic features of intracranial anatomy. [1][2][3][4][5][6][7][8][9][10][11] In particular, the value of this technique has been demonstrated in hydrocephalus and endoscopic third ventriculostomy. [12][13][14][15][16][17] The T2-weighted turbo spin-echo (TSE) sequence has commonly been used to study the CSF pathway in hydrocephalus; however, it fails to demonstrate thin membranes causing obstruction at various foraminal levels and cisterns.…”

“…1 Two true-fast imaging with steady-state precession sequences with differing radio-frequency pulses are combined for strong T2/T1-weighted high-resolution 3D images. [1][2][3][4] The advantage of the 3D-CISS sequence is its combination of high signal intensity levels and extremely high spatial resolution. During the past decade, 3D-CISS sequence has been introduced and used in the assessment of normal and pathologic features of intracranial anatomy.…”