Publications by Year: 2015

2015
Ritu R Gill, Yifan Zheng, Julianne S Barlow, Jagadeesan Jayender, Erin E Girard, Philip M Hartigan, Lucian R Chirieac, Carol J Belle-King, Kristen Murray, Christopher Sears, Jon O Wee, Michael T Jaklitsch, Yolonda L Colson, and Raphael Bueno. 2015. “Image-guided Video Assisted Thoracoscopic Surgery (iVATS) - Phase I-II Clinical Trial.” J Surg Oncol, 112, 1, Pp. 18-25.Abstract

PURPOSE: To facilitate localization and resection of small lung nodules, we developed a prospective clinical trial (ClinicalTrials.gov number NCT01847209) for a novel surgical approach which combines placement of fiducials using intra-operative C-arm computed tomography (CT) guidance with standard thoracoscopic resection technique using image-guided video-assisted thoracoscopic surgery (iVATS). METHODS: Pretrial training was performed in a porcine model using C-arm CT and needle guidance software. Methodology and workflow for iVATS was developed, and a multi-modality team was trained. A prospective phase I-II clinical trial was initiated with the goal of recruiting eligible patients with small peripheral pulmonary nodules. Intra-operative C-arm CT scan was utilized for guidance of percutaneous marking with two T-bars (Kimberly-Clark, Roswell, GA) followed by VATS resection of the tumor. RESULTS: Twenty-five patients were enrolled; 23 underwent iVATS, one withdrew, and one lesion resolved. Size of lesions were: 0.6-1.8 cm, mean = 1.3 ± 0.38 cm.. All 23 patients underwent complete resection of their lesions. CT imaging of the resected specimens confirmed the removal of the T-bars and the nodule. Average and total procedure radiation dose was in the acceptable low range (median = 1501 μGy*m(2), range 665-16,326). There were no deaths, and all patients were discharged from the hospital (median length of stay = 4 days, range 2-12). Three patients had postoperative complications: one prolonged air-leak, one pneumonia, and one ileus. CONCLUSIONS: A successful and safe step-wise process has been established for iVATS, combining intra-operative C-arm CT scanning and thoracoscopic surgery in a hybrid operating room.

Jinbang Guo, Howard J Huang, Xingan Wang, Wei Wang, Henry Ellison, Robert P Thomen, Andrew E Gelman, and Jason C Woods. 2015. “Imaging Mouse Lung Allograft Rejection with (1) H MRI.” Magn Reson Med, 73, 5, Pp. 1970-8.Abstract

PURPOSE: To demonstrate that longitudinal, noninvasive monitoring via MRI can characterize acute cellular rejection in mouse orthotopic lung allografts. METHODS: Nineteen Balb/c donor to C57BL/6 recipient orthotopic left lung transplants were performed, further divided into control-Ig versus anti-CD4/anti-CD8 treated groups. A two-dimensional multislice gradient-echo pulse sequence synchronized with ventilation was used on a small-animal MR scanner to acquire proton images of lung at postoperative days 3, 7, and 14, just before sacrifice. Lung volume and parenchymal signal were measured, and lung compliance was calculated as volume change per pressure difference between high and low pressures. RESULTS: Normalized parenchymal signal in the control-Ig allograft increased over time, with statistical significance between day 14 and day 3 posttransplantation (0.046→0.789; P < 0.05), despite large intermouse variations; this was consistent with histopathologic evidence of rejection. Compliance of the control-Ig allograft decreased significantly over time (0.013→0.003; P < 0.05), but remained constant in mice treated with anti-CD4/anti-CD8 antibodies. CONCLUSION: Lung allograft rejection in individual mice can be monitored by lung parenchymal signal changes and by lung compliance through MRI. Longitudinal imaging can help us better understand the time course of individual lung allograft rejection and response to treatment.

Patricia C Silveira, Ruth Dunne, Nisha I Sainani, Ronilda Lacson, Stuart G Silverman, Clare M Tempany, and Ramin Khorasani. 2015. “Impact of an Information Technology-Enabled Initiative on the Quality of Prostate Multiparametric MRI Reports.” Acad Radiol, 22, 7, Pp. 827-33.Abstract
RATIONALE AND OBJECTIVES: Assess the impact of implementing a structured report template and a computer-aided diagnosis (CAD) tool on the quality of prostate multiparametric magnetic resonance imaging (mp-MRI) reports. MATERIALS AND METHODS: Institutional Review Board approval was obtained for this Health Insurance Portability and Accountability Act-compliant study performed at an academic medical center. The study cohort included all prostate mp-MRI reports (n = 385) finalized 6 months before and after implementation of a structured report template and a CAD tool (collectively the information technology [IT] tools) integrated into the picture archiving and communication system workstation. Primary outcome measure was quality of prostate mp-MRI reports. An expert panel of our institution's subspecialty-trained abdominal radiologists defined prostate mp-MRI report quality as optimal, satisfactory, or unsatisfactory based on documentation of nine variables. Reports were reviewed to extract the predefined quality variables and determine whether the IT tools were used to create each report. Chi-square and Student's t tests were used to compare report quality before and after implementation of IT tools. RESULTS: The overall proportion of optimal or satisfactory reports increased from 29.8% (47/158) to 53.3% (121/227) (P < .001) after implementing the IT tools. Although the proportion of optimal or satisfactory reports increased among reports generated using at least one of the IT tools (47/158 = [29.8%] vs. 105/161 = [65.2%]; P < .001), there was no change in quality among reports generated without use of the IT tools (47/158 = [29.8%] vs. 16/66 = [24.2%]; P = .404). CONCLUSIONS: The use of a structured template and CAD tool improved the quality of prostate mp-MRI reports compared to free-text report format and subjective measurement of contrast enhancement kinetic curve.
Ming Li, Feng Gao, Jayender Jagadeesan, Ritu R Gill, Yanqing Hua, and Xiangpeng Zheng. 2015. “Incremental Value of Contrast Enhanced Computed Tomography on Diagnostic Accuracy in Evaluation of Small Pulmonary Ground Glass Nodules.” J Thorac Dis, 7, 9, Pp. 1606-15.Abstract

BACKGROUND: To evaluate the information gain by the application of both non-contrast and contrast enhanced computed tomography (CT) with extended mediastinal display window settings in the evaluation of pure ground glass nodules (pGGNs) and or mixed ground glass nodules (mGGNs) in the context of pre-invasive or early stage lung adenocarcinoma. METHODS: One hundred and fifty patients with ground glass nodules (GGNs) and mGGNs, with contrast enhanced CT scans within 2 weeks of thoracic surgery were included in the study. Quantitative evaluation of all nodules was performed in a conventional mediastinal window (CMW) and an extended mediastinal window (EMW) both on non-contrast images and contrast-enhanced images. RESULTS: Contrast-enhanced images with CMW demonstrated amplification of solid portion in 23 (43%), 41 (77%) with EMW out of 53 minimally invasive adenocarcinoma (MIA) nodules, and in 34 of 37 (91%) of invasive adenocarcinoma (IAC) nodules. Using the increase in size of solid portion of the nodule measured on the enhanced CT images with EMW, area under the receiver operating characteristic (ROC) curve of 0.872 and 0.899 was utilized for differentiating between the pre-invasive nodules and MIA and between MIA and IAC nodules, respectively. Statistically significant differences existed between the pre-invasive and the MIA groups, and MIA and the IAC groups in smaller nodules (P<0.01). CONCLUSIONS: Comparative quantitative analysis of the pre and post contrast images can help differentiate between atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), MIAs, and IACs. Extension of the CT mediastinal window setting improves the evaluation of small GGNs, and can augment the diagnostic accuracy when evaluating small pGGNs and mGGNs.

Olutayo Olubiyi, Aysegul Ozdemir, Fatih Incekara, Yanmei Tie, Parviz Dolati, Liangge Hsu, Sandro Santagata, Zhenrui Chen, Laura Rigolo, and Alexandra J Golby. 2015. “Intraoperative Magnetic Resonance Imaging in Intracranial Glioma Resection: A Single-Center, Retrospective Blinded Volumetric Study.” World Neurosurg, 84, 2, Pp. 528-36.Abstract

BACKGROUND: Intraoperative magnetic resonance imaging (IoMRI) was devised to overcome brain shifts during craniotomies. Yet, the acceptance of IoMRI is limited. OBJECTIVE: To evaluate impact of IoMRI on intracranial glioma resection outcome including overall patient survival. METHODS: A retrospective review of records was performed on a cohort of 164 consecutive patients who underwent resection surgery for newly diagnosed intracranial gliomas either with or without IoMRI technology performed by 2 neurosurgeons in our center. Patient follow-up was at least 5 years. Extent of resection (EOR) was calculated using pre- and postoperative contrast-enhanced and T2-weighted MR-images. Adjusted analysis was performed to compare gross total resection (GTR), EOR, permanent surgery-associated neurologic deficit, and overall survival between the 2 groups. RESULTS: Overall median EOR was 92.1%, and 97.45% with IoMRI use and 89.9% without IoMRI, with crude (unadjusted) P < 0.005. GTR was achieved in 49.3% of IoMRI cases, versus in only 21.4% of no-IoMRI cases, P < 0.001. GTR achieved was more with the use of IoMRI among gliomas located in both eloquent and noneloquent brain areas, P = 0.017 and <0.001, respectively. Permanent surgery-associated neurologic deficit was not (statistically) more significant with no-IoMRI, P = 0.284 (13.8% vs. 6.7%). In addition, the IoMRI group had better 5-year overall survival, P < 0.001. CONCLUSION: This study shows that the use of IoMRI was associated with greater rates of EOR and GTR, and better overall 5-year survival in both eloquent brain areas located and non-eloquent brain areas located gliomas, with no increased risk of neurologic complication.

C Wachinger, M Toews, G Langs, William M Wells III, and P Golland. 2015. “Keypoint Transfer Segmentation.” Inf Process Med Imaging, 24, Pp. 233-45.Abstract

We present an image segmentation method that transfers label maps of entire organs from the training images to the novel image to be segmented. The transfer is based on sparse correspondences between keypoints that represent automatically identified distinctive image locations. Our segmentation algorithm consists of three steps: (i) keypoint matching, (ii) voting-based keypoint labeling, and (iii) keypoint-based probabilistic transfer of organ label maps. We introduce generative models for the inference of keypoint labels and for image segmentation, where keypoint matches are treated as a latent random variable and are marginalized out as part of the algorithm. We report segmentation results for abdominal organs in whole-body CT and in contrast-enhanced CT images. The accuracy of our method compares favorably to common multi-atlas segmentation while offering a speed-up of about three orders of magnitude. Furthermore, keypoint transfer requires no training phase or registration to an atlas. The algorithm's robustness enables the segmentation of scans with highly variable field-of-view.

Amelie Meyer, Andras Lasso, Tamas Ungi, and Gabor Fichtinger. 2015. “Live Ultrasound Volume Reconstruction using Scout Scanning.” Proc SPIE Int Soc Opt Eng, 9415.Abstract

INTRODUCTION: Ultrasound-guided interventions often necessitate scanning of deep-seated anatomical structures that may be hard to visualize. Visualization can be improved using reconstructed 3D ultrasound volumes. High-resolution 3D reconstruction of a large area during clinical interventions is challenging if the region of interest is unknown. We propose a two-stage scanning method allowing the user to perform quick low-resolution scouting followed by high-resolution live volume reconstruction. METHODS: Scout scanning is accomplished by stacking 2D tracked ultrasound images into a low-resolution volume. Then, within a region of interest defined in the scout scan, live volume reconstruction can be performed by continuous scanning until sufficient image density is achieved. We implemented the workflow as a module of the open-source 3D Slicer application, within the SlicerIGT extension and building on the PLUS toolkit. RESULTS: Scout scanning is performed in a few seconds using 3 mm spacing to allow region of interest definition. Live reconstruction parameters are set to provide good image quality (0.5 mm spacing, hole filling enabled) and feedback is given during live scanning by regularly updated display of the reconstructed volume. DISCUSSION: Use of scout scanning may allow the physician to identify anatomical structures. Subsequent live volume reconstruction in a region of interest may assist in procedures such as targeting needle interventions or estimating brain shift during surgery.

Mukund Balasubramanian, Robert V. Mulkern, William M Wells III, Padmavathi Sundaram, and Darren B Orbach. 2015. “Magnetic Resonance Imaging of Ionic Currents in Solution: The Effect of Magnetohydrodynamic Flow.” Magn Reson Med, 74, 4, Pp. 1145-55.Abstract

PURPOSE: Reliably detecting MRI signals in the brain that are more tightly coupled to neural activity than blood-oxygen-level-dependent fMRI signals could not only prove valuable for basic scientific research but could also enhance clinical applications such as epilepsy presurgical mapping. This endeavor will likely benefit from an improved understanding of the behavior of ionic currents, the mediators of neural activity, in the presence of the strong magnetic fields that are typical of modern-day MRI scanners. THEORY: Of the various mechanisms that have been proposed to explain the behavior of ionic volume currents in a magnetic field, only one-magnetohydrodynamic flow-predicts a slow evolution of signals, on the order of a minute for normal saline in a typical MRI scanner. METHODS: This prediction was tested by scanning a volume-current phantom containing normal saline with gradient-echo-planar imaging at 3 T. RESULTS: Greater signal changes were observed in the phase of the images than in the magnitude, with the changes evolving on the order of a minute. CONCLUSION: These results provide experimental support for the MHD flow hypothesis. Furthermore, MHD-driven cerebrospinal fluid flow could provide a novel fMRI contrast mechanism.

Eva C Gombos, Jayender Jagadeesan, Danielle M Richman, and Daniel F Kacher. 2015. “Magnetic Resonance Imaging-Guided Breast Interventions: Role in Biopsy Targeting and Lumpectomies.” Magn Reson Imaging Clin N Am, 23, 4, Pp. 547-61.Abstract
Contrast-enhanced breast MR imaging is increasingly being used to diagnose breast cancer and to perform biopsy procedures. The American Cancer Society has advised women at high risk for breast cancer to have breast MR imaging screening as an adjunct to screening mammography. This article places special emphasis on biopsy and operative planning involving MR imaging and reviews use of breast MR imaging in monitoring response to neoadjuvant chemotherapy. Described are peer-reviewed data on currently accepted MR imaging-guided procedures for addressing benign and malignant breast diseases, including intraoperative imaging.
Ehud J Schmidt. 2015. “Magnetic Resonance Imaging-Guided Cardiac Interventions.” Magn Reson Imaging Clin N Am, 23, 4, Pp. 563-77.Abstract
Performing intraoperative cardiovascular procedures inside an MR imaging scanner can potentially provide substantial advantage in clinical outcomes by reducing the risk and increasing the success rate relative to the way such procedures are performed today, in which the primary surgical guidance is provided by X-ray fluoroscopy, by electromagnetically tracked intraoperative devices, and by ultrasound. Both noninvasive and invasive cardiologists are becoming increasingly familiar with the capabilities of MR imaging for providing anatomic and physiologic information that is unequaled by other modalities. As a result, researchers began performing animal (preclinical) interventions in the cardiovascular system in the early 1990s.
Wei Wang. 2015. “Magnetic Resonance-guided Active Catheter Tracking.” Magn Reson Imaging Clin N Am, 23, 4, Pp. 579-89.Abstract
Several advantages of MR imaging compared with other imaging modalities have provided the rationale for increased attention to MR-guided interventions, including its excellent soft tissue contrast, its capability to show both anatomic and functional information, and no use of ionizing radiation. An important aspect of MR-guided intervention is to provide visualization and navigation of interventional devices relative to the surrounding tissues. This article focuses on the methods for MR-guided active tracking in catheter-based interventions. Practical issues about implementation of active catheter tracking in a clinical setting are discussed and several current application examples are highlighted.
David Calligaris, Daniel R Feldman, Isaiah Norton, Olutayo Olubiyi, Armen N Changelian, Revaz Machaidze, Matthew L Vestal, Edward R Laws, Ian F Dunn, Sandro Santagata, and Nathalie YR Agar. 2015. “MALDI Mass Spectrometry Imaging Analysis of Pituitary Adenomas for Near-real-time Tumor Delineation.” Proc Natl Acad Sci U S A, 112, 32, Pp. 9978-83.Abstract

We present a proof of concept study designed to support the clinical development of mass spectrometry imaging (MSI) for the detection of pituitary tumors during surgery. We analyzed by matrix-assisted laser desorption/ionization (MALDI) MSI six nonpathological (NP) human pituitary glands and 45 hormone secreting and nonsecreting (NS) human pituitary adenomas. We show that the distribution of pituitary hormones such as prolactin (PRL), growth hormone (GH), adrenocorticotropic hormone (ACTH), and thyroid stimulating hormone (TSH) in both normal and tumor tissues can be assessed by using this approach. The presence of most of the pituitary hormones was confirmed by using MS/MS and pseudo-MS/MS methods, and subtyping of pituitary adenomas was performed by using principal component analysis (PCA) and support vector machine (SVM). Our proof of concept study demonstrates that MALDI MSI could be used to directly detect excessive hormonal production from functional pituitary adenomas and generally classify pituitary adenomas by using statistical and machine learning analyses. The tissue characterization can be completed in fewer than 30 min and could therefore be applied for the near-real-time detection and delineation of pituitary tumors for intraoperative surgical decision-making.

David Calligaris, Daniel R Feldman, Isaiah Norton, Priscilla K Brastianos, Ian F Dunn, Sandro Santagata, and Nathalie YR Agar. 2015. “Molecular Typing of Meningiomas by Desorption Electrospray Ionization Mass Spectrometry Imaging for Surgical Decision-Making.” Int J Mass Spectrom, 377, Pp. 690-8.Abstract

Meningiomas are the most frequent intracranial tumors. The majority is benign slow-growing tumors but they can be difficult to treat depending on their location and size. While meningiomas are well delineated on magnetic resonance imaging by their uptake of contrast, surgical limitations still present themselves from not knowing the extent of invasion of the dura matter by meningioma cells. The development of tools to characterize tumor tissue in real or near real time could prevent recurrence after tumor resection by allowing for more precise surgery, i.e. removal of tumor with preservation of healthy tissue. The development of ambient ionization mass spectrometry for molecular characterization of tissue and its implementation in the surgical decision-making workflow carry the potential to fulfill this need. Here, we present the characterization of meningioma and dura mater by desorption electrospray ionization mass spectrometry to validate the technique for the molecular assessment of surgical margins and diagnosis of meningioma from surgical tissue in real-time. Nine stereotactically resected surgical samples and three autopsy samples were analyzed by standard histopathology and mass spectrometry imaging. All samples indicated a strong correlation between results from both techniques. We then highlight the value of desorption electrospray ionization mass spectrometry for the molecular subtyping/subgrouping of meningiomas from a series of forty genetically characterized specimens. The minimal sample preparation required for desorption electrospray ionization mass spectrometry offers a distinct advantage for applications relying on real-time information such as surgical decision-making. The technology here was tested to distinguish meningioma from dura mater as an approach to precisely define surgical margins. In addition we classify meningiomas into fibroblastic and meningothelial subtypes and more notably recognize meningiomas with NF2 genetic aberrations.

Sona A Chikarmane, Eva C Gombos, Jayender Jagadeesan, Chandrajit Raut, and Jyothi P Jagannathan. 2015. “MRI Findings of Radiation-associated Angiosarcoma of the Breast (RAS).” J Magn Reson Imaging, 42, 3, Pp. 763-70.Abstract

PURPOSE: To describe the magnetic resonance imaging (MRI) characteristics of radiation-associated breast angiosarcomas (RAS). MATERIALS AND METHODS: In this Institutional Review board (IRB)-approved retrospective study, 57 women were diagnosed with pathologically confirmed RAS during the study period (January 1999 to May 2013). Seventeen women underwent pretreatment breast MRI (prior to surgical resection or chemotherapy), of which 16 studies were available for review. Imaging features, including all available mammograms, ultrasounds, and breast MRIs, of these patients were evaluated by two radiologists independently and correlated with clinical management and outcomes. RESULTS: The median age of patients at original breast cancer diagnosis was 69.3 years (range 42-84 years), with average time from initial radiation therapy to diagnosis of RAS of 7.3 years (range 5.1-9.5 years). Nine women had mammograms (9/16, 56%) and six had breast ultrasound (US) (6/16, 38%) prior to MRI, which demonstrated nonsuspicious findings in 5/9 mammograms and 3/6 ultrasounds. Four patients had distinct intraparenchymal masses on mammogram and MRI. MRI findings included diffuse T2 high signal skin thickening (16/16, 100%). Nearly half (7/16, 44%) of patients had T2 low signal intensity lesions; all lesions rapidly enhanced on postcontrast T1 -weighted imaging. All women underwent surgical resection, with 8/16 (50%) receiving neoadjuvant chemotherapy. Four women died during the study period. CONCLUSION: Clinical, mammographic, and sonographic findings of RAS are nonspecific and may be occult on conventional breast imaging; MRI findings of RAS include rapidly enhancing dermal and intraparenchymal lesions, some of which are low signal on T2 weighted imaging.

Lester Chee Hao Leong, Eva C Gombos, Jayender Jagadeesan, and Stephanie Man Chung Fook-Chong. 2015. “MRI kinetics with volumetric analysis in correlation with hormonal receptor subtypes and histologic grade of invasive breast cancers.” AJR Am J Roentgenol, 204, 3, Pp. W348-56.Abstract
OBJECTIVE. The aim of this study was to assess whether computer-assisted detection-processed MRI kinetics data can provide further information on the biologic aggressiveness of breast tumors. MATERIALS AND METHODS. We identified 194 newly diagnosed invasive breast cancers presenting as masses on contrast-enhanced MRI by a HIPAA-compliant pathology database search. Computer-assisted detection-derived data for the mean and median peak signal intensity percentage increase, most suspicious kinetic curve patterns, and volumetric analysis of the different kinetic patterns by mean percentage tumor volume were compared against the different hormonal receptor (estrogen-receptor [ER], progesterone-receptor [PR], ERRB2 (HER2/neu), and triple-receptor expressivity) and histologic grade subgroups, which were used as indicators of tumor aggressiveness. RESULTS. The means and medians of the peak signal intensity percentage increase were higher in ER-negative, PR-negative, and triple-negative (all p ≤ 0.001), and grade 3 tumors (p = 0.011). Volumetric analysis showed higher mean percentage volume of rapid initial enhancement in biologically more aggressive ER-negative, PR-negative, and triple-negative tumors compared with ER-positive (64% vs 53.6%, p = 0.013), PR-positive (65.4% vs 52.5%, p = 0.001), and nontriple-negative tumors (65.3% vs 54.6%, p = 0.028), respectively. A higher mean percentage volume of rapid washout component was seen in ERRB2-positive tumors compared with ERRB2-negative tumors (27.5% vs 17.9%, p = 0.020). CONCLUSION. Peak signal intensity percentage increase and volume analysis of the different kinetic patterns of breast tumors showed correlation with hormonal receptor and histologic grade indicators of cancer aggressiveness. Computer-assisted detection-derived MRI kinetics data have the potential to further characterize the aggressiveness of an invasive cancer.
Clare M Tempany, Jagadeesan Jayender, Tina Kapur, Raphael Bueno, Alexandra J Golby, Nathalie YR Agar, and Ferenc A Jolesz. 2015. “Multimodal Imaging for Improved Diagnosis and Treatment of Cancers.” Cancer, 121, 6, Pp. 817-27.Abstract

The authors review methods for image-guided diagnosis and therapy that increase precision in the detection, characterization, and localization of many forms of cancer to achieve optimal target definition and complete resection or ablation. A new model of translational, clinical, image-guided therapy research is presented, and the Advanced Multimodality Image-Guided Operating (AMIGO) suite is described. AMIGO was conceived and designed to allow for the full integration of imaging in cancer diagnosis and treatment. Examples are drawn from over 500 procedures performed on brain, neck, spine, thorax (breast, lung), and pelvis (prostate and gynecologic) areas and are used to describe how they address some of the many challenges of treating brain, prostate, and lung tumors. 

Parviz Dolati, Abdulkerim Gokoglu, Daniel Eichberg, Amir Zamani, Alexandra Golby, and Ossama Al-Mefty. 2015. “Multimodal Navigated Skull Base Tumor Resection using Image-based Vascular and Cranial Nerve Segmentation: A Prospective Pilot Study.” Surg Neurol Int, 6, Pp. 172.Abstract

BACKGROUND: Skull base tumors frequently encase or invade adjacent normal neurovascular structures. For this reason, optimal tumor resection with incomplete knowledge of patient anatomy remains a challenge. METHODS: To determine the accuracy and utility of image-based preoperative segmentation in skull base tumor resections, we performed a prospective study. Ten patients with skull base tumors underwent preoperative 3T magnetic resonance imaging, which included thin section three-dimensional (3D) space T2, 3D time of flight, and magnetization-prepared rapid acquisition gradient echo sequences. Imaging sequences were loaded in the neuronavigation system for segmentation and preoperative planning. Five different neurovascular landmarks were identified in each case and measured for accuracy using the neuronavigation system. Each segmented neurovascular element was validated by manual placement of the navigation probe, and errors of localization were measured. RESULTS: Strong correspondence between image-based segmentation and microscopic view was found at the surface of the tumor and tumor-normal brain interfaces in all cases. The accuracy of the measurements was 0.45 ± 0.21 mm (mean ± standard deviation). This information reassured the surgeon and prevented vascular injury intraoperatively. Preoperative segmentation of the related cranial nerves was possible in 80% of cases and helped the surgeon localize involved cranial nerves in all cases. CONCLUSION: Image-based preoperative vascular and neural element segmentation with 3D reconstruction is highly informative preoperatively and could increase the vigilance of neurosurgeons for preventing neurovascular injury during skull base surgeries. Additionally, the accuracy found in this study is superior to previously reported measurements. This novel preliminary study is encouraging for future validation with larger numbers of patients.

Helen Xu, Andras Lasso, Andriy Fedorov, Kemal Tuncali, Clare M Tempany, and Gabor Fichtinger. 2015. “Multi-slice-to-volume Registration for MRI-guided Transperineal Prostate Biopsy.” Int J Comput Assist Radiol Surg, 10, 5, Pp. 563-72.Abstract

PURPOSE: Prostate needle biopsy is a commonly performed procedure since it is the most definitive form of cancer diagnosis. Magnetic resonance imaging (MRI) allows target-specific biopsies to be performed. However, needle placements are often inaccurate due to intra-operative prostate motion and the lack of motion compensation techniques. This paper detects and determines the extent of tissue displacement during an MRI-guided biopsy so that the needle insertion plan can be adjusted accordingly. METHODS: A multi-slice-to-volume registration algorithm was developed to align the pre-operative planning image volume with three intra-operative orthogonal image slices of the prostate acquired immediately before needle insertion. The algorithm consists of an initial rigid transformation followed by a deformable step. RESULTS: A total of 14 image sets from 10 patients were studied. Based on prostate contour alignment, the registrations were accurate to within 2 mm. CONCLUSION: This algorithm can be used to increase the needle targeting accuracy by alerting the clinician if the biopsy target has moved significantly prior to needle insertion. The proposed method demonstrated feasibility of intra-operative target localization and motion compensation for MRI-guided prostate biopsy.

Yanmei Tie, Laura Rigolo, Aysegul Ozdemir Ovalioglu, Olutayo Olubiyi, Kelly L Doolin, Srinivasan Mukundan, and Alexandra J Golby. 2015. “A New Paradigm for Individual Subject Language Mapping: Movie-Watching fMRI.” J Neuroimaging, 25, 5, Pp. 710-20.Abstract

BACKGROUND: Functional MRI (fMRI) based on language tasks has been used in presurgical language mapping in patients with lesions in or near putative language areas. However, if patients have difficulty performing the tasks due to neurological deficits, it leads to unreliable or noninterpretable results. In this study, we investigate the feasibility of using a movie-watching fMRI for language mapping. METHODS: A 7-minute movie clip with contrasting speech and nonspeech segments was shown to 22 right-handed healthy subjects. Based on all subjects' language functional regions-of-interest, 6 language response areas were defined, within which a language response model (LRM) was derived by extracting the main temporal activation profile. Using a leave-one-out procedure, individuals' language areas were identified as the areas that expressed highly correlated temporal responses with the LRM derived from an independent group of subjects. RESULTS: Compared with an antonym generation task-based fMRI, the movie-watching fMRI generated language maps with more localized activations in the left frontal language area, larger activations in the left temporoparietal language area, and significant activations in their right-hemisphere homologues. Results of 2 brain tumor patients' movie-watching fMRI using the LRM derived from the healthy subjects indicated its ability to map putative language areas; while their task-based fMRI maps were less robust and noisier. CONCLUSIONS: These results suggest that it is feasible to use this novel "task-free" paradigm as a complementary tool for fMRI language mapping when patients cannot perform the tasks. Its deployment in more neurosurgical patients and validation against gold-standard techniques need further investigation.

Sebastian Tauscher, Junichi Tokuda, Günter Schreiber, Thomas Neff, Nobuhiko Hata, and Tobias Ortmaier. 2015. “OpenIGTLink Interface for State Control and Visualisation of a Robot for Image-guided Therapy Systems.” Int J Comput Assist Radiol Surg, 10, 3, Pp. 285-92.Abstract

PURPOSE: The integration of a robot into an image-guided therapy system is still a time consuming process, due to the lack of a well-accepted standard for interdevice communication. The aim of this project is to simplify this procedure by developing an open interface based on three interface classes: state control, visualisation, and sensor. A state machine on the robot control is added to the concept because the robot has its own workflow during surgical procedures, which differs from the workflow of the surgeon. METHODS: A KUKA Light Weight Robot is integrated into the medical technology environment of the Institute of Mechatronic Systems as a proof of concept. Therefore, 3D Slicer was used as visualisation and state control software. For the network communication the OpenIGTLink protocol was implemented. In order to achieve high rate control of the robot the "KUKA Sunrise. Connectivity SmartServo" package was used. An exemplary state machine providing states typically used by image-guided therapy interventions, was implemented. Two interface classes, which allow for a direct use of OpenIGTLink for robot control on the one hand and visualisation on the other hand were developed. Additionally, a 3D Slicer module was written to operate the state control. RESULTS: Utilising the described software concept the state machine could be operated by the 3D Slicer module with 20 Hz cycle rate and no data loss was detected during a test phase of approximately 270s (13,640 packages). Furthermore, the current robot pose could be sent with more than 60 Hz. No influence on the performance of the state machine by the communication thread could be measured. CONCLUSION: Simplified integration was achieved by using only one programming context for the implementation of the state machine, the interfaces, and the robot control. Eventually, the exemplary state machine can be easily expanded by adding new states.

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