Implications of Extracranial Distortion in Ultra-High-Field Magnetic Resonance Imaging for Image-Guided Cranial Neurosurgery
Voormolen, Eduard H; Diederen, Sander J H; Woerdeman, Peter; van der Sprenkel, Jan Willem Berkelbach; Noordmans, Herke Jan; Visser, Fredy; Viergever, Max A; Luijten, Peter; Hoogduin, Hans; Robe, Pierre A
(2019) World Neurosurgery, volume 126, pp. e250 - e258
(Article)
Abstract
BACKGROUND: Ultra-high-field magnetic resonance imaging (MRI) of the brain is attractive for image guidance during neurosurgery because of its high tissue contrast and detailed vessel visualization. However, high-field MRI is prone to distortion artifacts, which may compromise image guidance. Here we investigate intra- and extracranial distortions in 7-T MRI scans.
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METHODS: Five patients with and 5 patients without skin-adhesive fiducials received magnetization-prepared T1-weighted 7-T MRI and standard 3-T MRI scans. The 7- and 3-T images were rigidly coregistered and compared. Intracranial distortions were evaluated qualitatively, whereas shifts at the skin surface and shifts of the center positions of skin-adhesive fiducials were measured quantitatively. Moreover, we present an illustrative case of an ultra-high-field image-guided skull base meningioma resection. RESULTS: We found excellent intracranial correspondence between 3- and 7-T MRI scans. However, the average maximum skin shift was 6.8 ± 2.0 mm in group A and 5.2 ± 0.9 mm in group B. The average maximum difference between the skin-adhesive fiducial positions was 5.6 ± 3.1 mm in group B. In our tumor resection case, the meningioma blood supply could be targeted early thanks to 7-T image guidance, which made subsequent tumor removal straightforward. CONCLUSIONS: There are no visible intracranial distortions in magnetization-prepared T1-weighted 7-T MRI cranial images. However, we found considerable extracranial shifts. These shifts render 7-T images unreliable for patient-to-image registration. We recommend performing patient-to-image registration on a routine (computed tomography scan or 3-T magnetic resonance) image and subsequently fusing the 7-T magnetic resonance image with the routine image on the image guidance machine, until this issue is resolved.
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Keywords: 7 Tesla, Brain tumors, Geometric distortion, Image guidance, Neuronavigation, Ultra-high-field MRI, Meningioma/blood supply, Reproducibility of Results, Electromagnetic Fields, Humans, Magnetic Resonance Imaging/methods, Male, Skull Base Neoplasms/blood supply, Artifacts, Surgery, Computer-Assisted/methods, Adhesives, Aged, 80 and over, Adult, Female, Aged, Neurosurgical Procedures/methods, Phantoms, Imaging, Clinical Neurology, Surgery, Journal Article, Case Reports
ISSN: 1878-8750
Publisher: Elsevier Inc.
Note: Funding Information: Conflict of interest statement: This work was partly funded by the Alexandre Suerman personal grant received by Dr. Voormolen from the University Medical Center Utrecht , Utrecht, The Netherlands. The sponsor had no role in the design or conduct of this research. Dr. Visser is employed by Philips Healthcare, Best, The Netherlands, which is a manufacturer of 7.0-Tesla MRI scanners. Publisher Copyright: © 2019 Elsevier Inc.
(Peer reviewed)