NI-08 TRIAL AND PROBLEM OF USING ASL IN INTRAOPERATIVE MRI

Abstract

INTRODUCTIONMagnetic resonance perfusion imaging is considered to be available as grading of brain tumor and follow-up of brain treatment. One of the methods, arterial spin labeling (ASL), is a test that is useful for patients with renal impairment and contrast agent allergy and has low invasiveness because it does not use a contrast agent. However, there have been no reports of ASL in intraoperative MRI (iMRI).PURPOSEIn this hospital iMRI (1.5T), it was examined whether ASL could be used to evaluate residual tumor in patients under general anesthesia.CASE STUDYA 75-year-old woman with right temporal lobe Glioblastoma. 43-year-old man, left temporal lobe Diffuse astrocytoma. All performed ASL at the time of MRI imaging for navigation before induction of anesthesia just before surgery and iMRI. In all cases, the blood pressure at iMRI was maintained, and Post Label Delay (PLD) calculated the optimal PLD from the carotid artery velocity measured by iMRI, and defined it as 1800–2200 ms, and performed ASL.RESULTSActually, imaging by iMRI was almost difficult to visualize, and reflux was not recognized not only in the tumor but also in the gray matter.DISCUSSIONThe blood flow velocity measurement in the internal carotid artery is performed by the phase contrast method by intraoperative MRI, and the CBF decreases because propofol used during the operation decreases the CBF and also the brain metabolism. However, it has been suggested that it is one of the factors that make evaluation with ASL difficult. Although the iMRI of our hospital is 1.5 T, which is also a subject of investigation, it is thought that there is a limit to ASL imaging in the case of general anesthesia with propofol even from the calculated PLD.CONCLUSIONASL in iMRI at our hospital was not useful.