Abstract
The aim of the present case study was to investigate the advantages of intraoperative magnetic resonance imaging (iMRI) on the real-time guidance and monitoring of a stereotactic biopsy. The study describes a patient with intracranial lesions, which were examined by conventional MRI and diffusion tensor imaging using a 1.5T intraoperative MRI system. The digital and pre-operative positron emission/computed tomography image data were transferred to a BrainLAB planning workstation, and a variety of images were automatically fused. The BrainLAB software was then used to reconstruct the corticospinal tract (CST) and create a three-dimensional display of the anatomical association between the CST and the brain lesions. A Leksell surgical planning workstation was used to identify the ideal target site and a reasonable needle track for the biopsy. The 1.5T iMRI was used to effectively monitor the intracranial condition during the brain biopsy procedure. Post-operatively, the original symptoms of the patient were not aggravated and no further neurological deficits were apparent. The histopathological diagnosis of non-Hodgkin’s B-cell lymphoma was made. Using high-field iMRI, the multi-image fusion-guided stereotactic brain biopsy allows for a higher positive rate of biopsy and a lower incidence of complications. The approach of combining multi-image fusion images with the frame-based stereotactic biopsy may be clinically useful for intracranial lesions of deep functional areas.
Highlights
Intraoperative magnetic resonance imaging has the advantage of real‐time guidance and monitoring of the surgical procedure
To the best of our knowledge, the effects of high‐field Intraoperative magnetic resonance imaging (iMRI) in patients with basal ganglia region lesions who have undergone a frame‐based stereotactic brain biopsy have not yet been discussed in the literature
No study with this design, combining MRI‐positron emission tomography (PET)‐diffusion tensor imaging (DTI) fusion imaging with the stereotactic biopsy of a basal ganglia lesion, has been performed until now
Summary
Intraoperative magnetic resonance imaging (iMRI) has the advantage of real‐time guidance and monitoring of the surgical procedure. An 18F‐fluorodeoxyglucose (FDG)‐PET scan of the brain, performed two days prior to the surgery with the Discovery LS PET/computed tomography (CT) scanner (GE Medical Systems, Waukesha, WI, USA), revealed a focus of increased FDG uptake in the area of the left basal ganglia. The high‐field iMRI data collection, surgical planning and stereotactic brain biopsy were performed on the same day. The contrast‐enhanced MRI and pre‐operative PET/CT data were transferred into the stereotaxic planning system software, Leksell SurgiPlan 10.1 (Elekta), for image fusion. The immediate post‐operative MRI identified no surgical bleeding or other complications, and comparison of the pre‐operative planning imaging was performed to ensure that the target biopsy trajectory had been achieved (Fig. 3B). At the one-year follow-up, the patient was alive and free of disease
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