1 year of experiences with fmri, DTI in neuronavigation

1 year of experiences with fMRI, DTI in neuronavigation Poster No.:

C-1604

Congress:

ECR 2012

Type:

Scientific Paper

Authors:

J. Luxemburgova ,

Author Janel Davidson

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JOURNAL TRANSCRIPT
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:

10.1594/ecr2012/C-1604

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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

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Images for this section:

Fig. 1: Neuronavigational machine fy.Medtronic © google

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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

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Images for this section:

Fig. 2: Front projection through the window, using mirror, to screen in examination room © department of radiology

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Fig. 3: Subdural strip replaced in the area close to central sulcus © google

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Fig. 4: SSEP Mapping- cortical somatosensory evoked potentials are used to locate the central sulcus. © google

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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

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Images for this section:

Fig. 5: neuronavigational probe on the surface of the brain © google

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Fig. 6: Case No.1 Cavernomain nondominant hemisphere, FLAIR VISTA 3D, sagital view © Radiology dep.

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Fig. 7: Case No.1 Cavernomain nondominant hemisphere, FLAIR VISTA 3D, coronar view © Radiology dep.

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Fig. 8: Case No.1 Cavernomain nondominant hemisphere, FLAIR VISTA 3D,transverse view © Radiology dep.

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Fig. 9: Case No.1 fMRI- verb generation,activation in Broca and Wernicke areas, SMA rostral © Radiology dep.

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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

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Fig. 11: Case No.1 DTI- right corticospinal tract close to lesion, koronar view. Postoperative temporary left hemiparesis © Radiology dep.

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Fig. 12: Case No. 2 GBM in primary motor area neuronavigation T1W 3D TFE, coronar view © Radiology dep.

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Fig. 13: Case No. 2 GBM in primary motor area neuronavigation T1W 3D TFE, transverse view © Radiology dep.

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Fig. 14: Case No. 2 GBM in primary motor area neuronavigation T1W 3D TFE, sagital view © Radiology dep.

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Fig. 15: Case No. 2 fMRI- finger tapping right hand,activation in hand knob of left precentral gyrus, close to lesion © Radiology dep.

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Fig. 16: Case No. 2 fMRI- lipsactivation in lateral part of left precentral gyrus, close to lesion © Radiology dep.

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Fig. 17: Case No.2 DTI- corticospinal tract, coronar view © Radiology dep.

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Fig. 18: Case No. 2 DTI- corticospinal tract, lateral view © Radiology dep.

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Fig. 19: Case No. 3 Sole metastasis, in central area, neuronavigation T1W 3D TFE, transverse view © Radiology dep.

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Fig. 20: Case No. 3 Sole metastasis, in central area, neuronavigation T1W 3D TFE, sag © Radiology dep.

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Fig. 21: Case No.3 Sole metastasis, in central area, neuronavigation T1W 3D TFE, sag © Radiology dep.

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Fig. 22: Case No. 3 fMRI- finger tapping right hand,activation in hand knob of left precentral gyrus, caudal SMA © Radiology dep.

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Fig. 23: Case No. 3 fMRI- tongue,no activation in lower part of left precentral gyrus © Radiology dep.

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Fig. 24: Case No. 3 fMRI- verbal fluency,activation in Broca and Wernicke area, SMA area © Radiology dep.

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Fig. 25: Case No. 3 DTI- corticospinal tract, transverse view © Radiology dep.

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Fig. 26: Case No. 3 DTI- corticospinal tract, coronar view © Radiology dep.

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Fig. 27: Case No.4 GBM -preoperative MR, Infiltration of SMA medial sin, T1W 3D TFE, sagital view © Radiology dep.

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Fig. 28: Case No. 4 GBM -preoperative MR, Infiltration of SMA medial sin, T1W 3D TFE, coronar view © Radiology dep.

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Fig. 29: Case No. 4 GBM -preoperative MR, Infiltration of SMA medial sin, T1W 3D TFE, transverse view © Radiology dep.

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Fig. 30: Case No. 4 fMRI : finger tapping right hand,activation in hand knob of left precentral gyrus © Radiology dep.

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Fig. 31: Case No. 4 DTI- corticospinal tract, interhemispheric connections © Radiology dep.

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Fig. 32: Case No. 4 DTI- corticospinal tract, interhemispheric connections © Radiology dep.

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Fig. 33: Case No.4 DTI- corticospinal tract, interhemispheric connections © Radiology dep.

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Fig. 34: Case No. 4 PostoperativeMR, temporary deficit- speech and motor arest © Radiology dep.

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Fig. 35: Case No.4 PostoperativeMR, temporary deficit- speech and motor arest © Radiology dep.

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Fig. 36: Case No. 4 PostoperativeMR, temporary deficit- speech and motor arest © Radiology dep.

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Fig. 68: Case No. 7 Anaplastic oligodendroglioma. DTI- CST dxventral dislocated, close to lesion © Radiology dep.

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Fig. 67: Case No. 7 Anaplastic oligodendroglioma. DTI- CST dxventral dislocated, close to lesion © Radiology dep.

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Fig. 69: Case No. 7 Anaplastic oligodendroglioma. Neuronavigation T1W 3D TFE, transverse view Performed navigated biopsy © Radiology dep.

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Fig. 66: Case No. 7 Anaplastic oligodendroglioma. DTI- CST dxventral dislocated, close to lesion © Radiology dep.

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Fig. 65: Case No.7 Anaplastodendroglioma. fMRI- finger tapping left hand,activation in ventral dislocated right precentral gyrus © Radiology dep.

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Fig. 70: Case No. 7 Anaplastic oligodendroglioma. Neuronavigation T1W 3D TFE, transverse view Performed navigated biopsy © Radiology dep.

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Fig. 62: Case No. 7 Anaplasticoligodendroglioma, transverse view, CE T1W/MTC © Radiology dep.

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Fig. 37: Case No.5 Anaplastic astrocytoma,preoperative MR, neuronavigation T1W 3D TFE © Radiology dep.

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Fig. 38: Case No.5 Anaplastic astrocytomapreoperative MR, neuronavigation T1W 3D TFE © Radiology dep.

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Fig. 39: Case No. 5 Anaplastic astrocytomapreoperative MR, FLAIR VISTA 3D © Radiology dep.

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Fig. 40: Case No. 5 fMRI: finger tapping left handactivation in ventral dislocated right precentral gyrus © Radiology dep.

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Fig. 41: Case No. 5 fMRI- tongueactivation in lower part of dislocated right precentral gyrus © Radiology dep.

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Fig. 42: Case No. 5 DTI- corticospinal tract © Radiology dep.

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Fig. 43: case No. 5 DTI- corticospinal tract © Radiology dep.

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Fig. 44: Case No. 5 PostoperativeMR, transverse view © Radiology dep.

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Fig. 45: Case No. 5 PostoperativeMR, coronar view © Radiology dep.

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Fig. 46: Case No. 5 PostoperativeMR, sagital view © Radiology dep.

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Fig. 47: Case No. 6 Anaplastic oligodendroglioma-preoperative MR, transverse view © Radiology dep.

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Fig. 48: Case No. 6 Anaplastic oligodendroglioma-preoperative MR,sagital view © Radiology dep.

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Fig. 49: Case No. 6 Anaplastic oligodendroglioma-preoperative MR,coronar view © Radiology dep.

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Fig. 50: Case No.6 fMRI- finger tapping right hand,activation in hand knob of left precentral gyrus © Radiology dep.

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Fig. 51: Case No. 6 fMRI- finger tapping right footactivation medial part of left precentral gyrus, SMA medial dx © Radiology dep.

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Fig. 52: case No. 6 DTI- corticospinal tract © Radiology dep.

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Fig. 53: case No. 6 DTI- corticospinal tract © Radiology dep.

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Fig. 54: Case No. 6 postoperative MR, transverse view, radical resection © Radiology dep.

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Fig. 55: Case No. 6 postoperative MR, coronar view, radical resection © Radiology dep.

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Fig. 56: Case No. 6 postoperative MR, transverse view, radical resection © Radiology dep.

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Fig. 57: Case No. 6 Follow up, recurrence, transverse view, CE T1W/SE © Radiology dep.

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Fig. 58: Case No. 6 Follow up, recurrence, koronar view, CE FLAIR © Radiology dep.

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Fig. 59: Case No. 6 Follow up, recurrence, sagital view, T1W/SE © Radiology dep.

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Fig. 60: Case No. 7 Anaplasticoligodendroglioma, transverse view, T2W/TSE © Radiology dep.

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Fig. 61: Case No. 7 Anaplasticoligodendroglioma, transverse view, T2W/TSE © Radiology dep.

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Fig. 63: Case No. 7 Anaplatic oligodendroglioma, FLAIR transverse view. Right central area- infiltration or dislocation? © Radiology dep.

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Fig. 64: Case No. 7 Anaplastic oligodendroglioma. FLAIR transverse view. Right central area- infiltration or dislocation? © Radiology dep.

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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

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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

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Personal Information Neuroradiologist, MR dep. Hospital Jablonec n. Nisou, Czech Rep. [email protected] Neurosurgeon, Neurosurgery dep. Reg. Hospital, Liberec, Czech Rep. [email protected]

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