1 year of experiences with fmri, DTI in neuronavigation

Transcription

1 1 year of experiences with fmri, DTI in neuronavigation Poster No.: C-1604 Congress: ECR 2012 Type: Scientific Paper Authors: J. Luxemburgova, M. Kaiser ; Jablonec nad Nisou/CZ, Liberec/ CZ Keywords: Neuroradiology brain, MR-Functional imaging, Computer Applications-3D, Computer Applications-Detection, diagnosis, Computer Applications-General, Neoplasia, Metastases DOI: /ecr2012/C Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 77

2 Purpose One year experience at Magnetic Resonance Department, Hospital Jablonec nad Nisou, Czech Republic with Functional Magnetic Resonance Imaging, Diffusion Tensor Imaging in neuronavigation in co-operation with Neurosurgery Department, Regional Hospital Liberec, Czech Republic Authors: Jana Luxemburgova Magnetic Resonance Department Hospital Jablonec nad Nisou, Czech Republic Miroslav Kaiser Neurosurgery Department, Regional Hospital Liberec, Czech Republic Page 2 of 77

3 Images for this section: Fig. 1: Neuronavigational machine fy.medtronic google Page 3 of 77

4 Methods and Materials 1/ DATA ACQUISITION: MR Philips Achieva 1.5T, Extended MR WorkSpace - anatomical underlay: neuronavigation T1W 3D TFE sag - fmri: FE EPI BOLD, software IV BOLD showing paradigmas by front projection through the window, using mirror, reflexed on a screen placed in examination room choice of paradigmas - motor task, speech task, vizual activation using block design paradigm: 4x action changing with 4x relax -tractography: DTI medium SENSE, software Fibertrak 2/ CLINICAL APPLICATION: Preoperative localization of eloquent cortex, correlation with anatomical "landmark" Localization of tracts: cortico spinal tract, fasciculus arcuatus, radiatio optica Determination of the types of tracts alteration: a/ deviation in cases of low grade gliomas, anaplastic astrocytomas, glioblastoma multiforme and metastasis, b/ infiltration in cases of anaplastic astrocytomas, glioblastoma multiforme, c/ destruction in cases of anaplastic astrocytomas, glioblastoma multiforme Speech lateralization - determination of speech dominance Brain plasticity Validation of the data with the direct cortical stimulation using subdural strips - localization of central sulcus Page 4 of 77

5 Images for this section: Fig. 2: Front projection through the window, using mirror, to screen in examination room department of radiology Page 5 of 77

6 Fig. 3: Subdural strip replaced in the area close to central sulcus google Page 6 of 77

7 Fig. 4: SSEP Mapping- cortical somatosensory evoked potentials are used to locate the central sulcus. google Page 7 of 77

8 Results Aims of functional imaging: Increase safety of neurosurgical resection at tumours in eloquent areas Choice of optimal surgical approach Reach maximal possible extent of resection with minimal postoperative morbidity, especially incases of low grade gliomas in young patients Minimize postoperative permanent deficit Statistics: In period of one year - from June 2010 to June 2011, 50 patients were examined - there of 40 were operated, 5 were biopted, 5 were observed Indication: mostly glial tumours low and high grade, within or close to eloquent areas, cavernomas, metastasis Results: all patients without serious postoperative neurological deficit, or without progression existing neurological deficit One serious postoperative complication - bleeding Page 8 of 77

9 Images for this section: Fig. 5: neuronavigational probe on the surface of the brain google Page 9 of 77

10 Fig. 6: Case No.1 Cavernomain nondominant hemisphere, FLAIR VISTA 3D, sagital view Page 10 of 77

11 Fig. 7: Case No.1 Cavernomain nondominant hemisphere, FLAIR VISTA 3D, coronar view Page 11 of 77

12 Fig. 8: Case No.1 Cavernomain nondominant hemisphere, FLAIR VISTA 3D,transverse view Page 12 of 77

13 Fig. 9: Case No.1 fmri- verb generation,activation in Broca and Wernicke areas, SMA rostral Page 13 of 77

14 Fig. 10: Case No.1 DTI- right corticospinal tract close to lesion, transverse view. Postoperative temporary left hemiparesis Radiology, Hospital Jablonec n.nisou - Jablonec nad Nisou/CZ Page 14 of 77

15 Fig. 11: Case No.1 DTI- right corticospinal tract close to lesion, koronar view. Postoperative temporary left hemiparesis Page 15 of 77

16 Fig. 12: Case No. 2 GBM in primary motor area neuronavigation T1W 3D TFE, coronar view Page 16 of 77

17 Fig. 13: Case No. 2 GBM in primary motor area neuronavigation T1W 3D TFE, transverse view Page 17 of 77

18 Fig. 14: Case No. 2 GBM in primary motor area neuronavigation T1W 3D TFE, sagital view Page 18 of 77

19 Fig. 15: Case No. 2 fmri- finger tapping right hand,activation in hand knob of left precentral gyrus, close to lesion Page 19 of 77

20 Fig. 16: Case No. 2 fmri- lipsactivation in lateral part of left precentral gyrus, close to lesion Page 20 of 77

21 Fig. 17: Case No.2 DTI- corticospinal tract, coronar view Page 21 of 77

22 Fig. 18: Case No. 2 DTI- corticospinal tract, lateral view Page 22 of 77

23 Fig. 19: Case No. 3 Sole metastasis, in central area, neuronavigation T1W 3D TFE, transverse view Page 23 of 77

24 Fig. 20: Case No. 3 Sole metastasis, in central area, neuronavigation T1W 3D TFE, sag Page 24 of 77

25 Fig. 21: Case No.3 Sole metastasis, in central area, neuronavigation T1W 3D TFE, sag Page 25 of 77

26 Fig. 22: Case No. 3 fmri- finger tapping right hand,activation in hand knob of left precentral gyrus, caudal SMA Page 26 of 77

27 Fig. 23: Case No. 3 fmri- tongue,no activation in lower part of left precentral gyrus Page 27 of 77

28 Fig. 24: Case No. 3 fmri- verbal fluency,activation in Broca and Wernicke area, SMA area Page 28 of 77

29 Fig. 25: Case No. 3 DTI- corticospinal tract, transverse view Page 29 of 77

30 Fig. 26: Case No. 3 DTI- corticospinal tract, coronar view Page 30 of 77

31 Fig. 27: Case No.4 GBM -preoperative MR, Infiltration of SMA medial sin, T1W 3D TFE, sagital view Page 31 of 77

32 Fig. 28: Case No. 4 GBM -preoperative MR, Infiltration of SMA medial sin, T1W 3D TFE, coronar view Page 32 of 77

33 Fig. 29: Case No. 4 GBM -preoperative MR, Infiltration of SMA medial sin, T1W 3D TFE, transverse view Page 33 of 77

34 Fig. 30: Case No. 4 fmri : finger tapping right hand,activation in hand knob of left precentral gyrus Page 34 of 77

35 Fig. 31: Case No. 4 DTI- corticospinal tract, interhemispheric connections Page 35 of 77

36 Fig. 32: Case No. 4 DTI- corticospinal tract, interhemispheric connections Page 36 of 77

37 Fig. 33: Case No.4 DTI- corticospinal tract, interhemispheric connections Page 37 of 77

38 Fig. 34: Case No. 4 PostoperativeMR, temporary deficit- speech and motor arest Page 38 of 77

39 Fig. 35: Case No.4 PostoperativeMR, temporary deficit- speech and motor arest Page 39 of 77

40 Fig. 36: Case No. 4 PostoperativeMR, temporary deficit- speech and motor arest Page 40 of 77

41 Fig. 68: Case No. 7 Anaplastic oligodendroglioma. DTI- CST dxventral dislocated, close to lesion Page 41 of 77

42 Fig. 67: Case No. 7 Anaplastic oligodendroglioma. DTI- CST dxventral dislocated, close to lesion Page 42 of 77

43 Fig. 69: Case No. 7 Anaplastic oligodendroglioma. Neuronavigation T1W 3D TFE, transverse view Performed navigated biopsy Page 43 of 77

44 Fig. 66: Case No. 7 Anaplastic oligodendroglioma. DTI- CST dxventral dislocated, close to lesion Page 44 of 77

45 Fig. 65: Case No.7 Anaplastodendroglioma. fmri- finger tapping left hand,activation in ventral dislocated right precentral gyrus Page 45 of 77

46 Fig. 70: Case No. 7 Anaplastic oligodendroglioma. Neuronavigation T1W 3D TFE, transverse view Performed navigated biopsy Page 46 of 77

47 Fig. 62: Case No. 7 Anaplasticoligodendroglioma, transverse view, CE T1W/MTC Page 47 of 77

48 Fig. 37: Case No.5 Anaplastic astrocytoma,preoperative MR, neuronavigation T1W 3D TFE Page 48 of 77

49 Fig. 38: Case No.5 Anaplastic astrocytomapreoperative MR, neuronavigation T1W 3D TFE Page 49 of 77

50 Fig. 39: Case No. 5 Anaplastic astrocytomapreoperative MR, FLAIR VISTA 3D Page 50 of 77

51 Fig. 40: Case No. 5 fmri: finger tapping left handactivation in ventral dislocated right precentral gyrus Page 51 of 77

52 Fig. 41: Case No. 5 fmri- tongueactivation in lower part of dislocated right precentral gyrus Page 52 of 77

53 Fig. 42: Case No. 5 DTI- corticospinal tract Page 53 of 77

54 Fig. 43: case No. 5 DTI- corticospinal tract Page 54 of 77

55 Fig. 44: Case No. 5 PostoperativeMR, transverse view Page 55 of 77

56 Fig. 45: Case No. 5 PostoperativeMR, coronar view Page 56 of 77

57 Fig. 46: Case No. 5 PostoperativeMR, sagital view Page 57 of 77

58 Fig. 47: Case No. 6 Anaplastic oligodendroglioma-preoperative MR, transverse view Page 58 of 77

59 Fig. 48: Case No. 6 Anaplastic oligodendroglioma-preoperative MR,sagital view Page 59 of 77

60 Fig. 49: Case No. 6 Anaplastic oligodendroglioma-preoperative MR,coronar view Page 60 of 77

61 Fig. 50: Case No.6 fmri- finger tapping right hand,activation in hand knob of left precentral gyrus Page 61 of 77

62 Fig. 51: Case No. 6 fmri- finger tapping right footactivation medial part of left precentral gyrus, SMA medial dx Page 62 of 77

63 Fig. 52: case No. 6 DTI- corticospinal tract Page 63 of 77

64 Fig. 53: case No. 6 DTI- corticospinal tract Page 64 of 77

65 Fig. 54: Case No. 6 postoperative MR, transverse view, radical resection Page 65 of 77

66 Fig. 55: Case No. 6 postoperative MR, coronar view, radical resection Page 66 of 77

67 Fig. 56: Case No. 6 postoperative MR, transverse view, radical resection Page 67 of 77

68 Fig. 57: Case No. 6 Follow up, recurrence, transverse view, CE T1W/SE Page 68 of 77

69 Fig. 58: Case No. 6 Follow up, recurrence, koronar view, CE FLAIR Page 69 of 77

70 Fig. 59: Case No. 6 Follow up, recurrence, sagital view, T1W/SE Page 70 of 77

71 Fig. 60: Case No. 7 Anaplasticoligodendroglioma, transverse view, T2W/TSE Page 71 of 77

72 Fig. 61: Case No. 7 Anaplasticoligodendroglioma, transverse view, T2W/TSE Page 72 of 77

73 Fig. 63: Case No. 7 Anaplatic oligodendroglioma, FLAIR transverse view. Right central area- infiltration or dislocation? Page 73 of 77

74 Fig. 64: Case No. 7 Anaplastic oligodendroglioma. FLAIR transverse view. Right central area- infiltration or dislocation? Page 74 of 77

75 Conclusion promptly developing method, time consuming demanding cooperation from patient requiring interdisciplinary consultation between neurosurgeon and neuroradiologist - in preoperative planning: determination the distance between the lesion and eloquent areas or tracts, - in postoperative care: clinical status of pacient, extent of resection, complications and follow-up facilitate the choice of optimal operative approach maximizing extent of resection with minimizing risk of permanent neurological deficit Page 75 of 77

76 References C.Stippich Clinical Functional MRI- Presurgical Functional Neuroimaging Stephan Ulmer,Olav Jansen- fmri-basics and Clinical Applications Jeremy Schmahmann, Deepak Pandya- Fiber pathways of the Brain Richard B.Buxton-Introduction to Functional Magnetic Resonance Imaging Principles and Techniques Susumu Mori- Introdiction to Diffusion Tensor Imaging Orhan Arslan- Neuroanatomical basis of Clinical Neurology Massimo Filippi- fmri Techniques and Protocols Scott H.Faro, Feroze B. Mohamed- Functional MRI Jonathan Gillard, Adam Baldman, Peter Barker: Clinical MR Neuroimaging, diffusion, perfusion, spectroscopy Sotirios A. Tsementzis: Differential Diagnosis in Neurology and Neurosurgery, A Clinical Pocket Guide Christoph Mulert Louis Lemieuks: EEG-fMRI, Physiological Basis, Technique and Applications Page 76 of 77

77 Personal Information Neuroradiologist, MR dep. Hospital Jablonec n. Nisou, Czech Rep. Neurosurgeon, Neurosurgery dep. Reg. Hospital, Liberec, Czech Rep. Page 77 of 77