Nimsky Christopher, Ganslandt Oliver, Hastreiter Peter, Wang Ruopeng, Benner Thomas, Sorensen A Gregory, Fahlbusch Rudolf
Department of Neurosurgery, University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
Radiology. 2005 Jan;234(1):218-25. doi: 10.1148/radiol.2341031984. Epub 2004 Nov 24.
To prospectively evaluate the location of white matter tracts with diffusion-tensor imaging (DTI) during neurosurgical procedures.
Ethical committee approval and signed informed consent were obtained. A 1.5-T magnetic resonance imager with an adapted rotating surgical table that is placed in a radiofrequency-shielded operating theater was used for pre- and intraoperative imaging. DTI was performed by applying an echo-planar imaging sequence with six diffusion directions in 38 patients (20 female patients, 18 male patients; age range, 7-77 years; mean age, 45.6 years) who were undergoing surgery (35 craniotomy and three burr hole procedures). Color-encoded maps of fractional anisotropy were generated by depicting white matter tracts. A rigid registration algorithm was used to compare pre- and intraoperative images.
Intraoperative DTI was technically feasible in all patients, and no major image distortions occurred in the areas of interest. Pre- and intraoperative color-encoded maps of fractional anisotropy could be registered; these maps depicted marked and highly variable shifting of white matter tracts during neurosurgical procedures. In the 27 patients who underwent brain tumor resection, white matter tract shifting ranged from an inward shift of 8 mm to an outward shift of 15 mm (mean shift +/- standard deviation, outward shift of 2.5 mm +/- 5.8). In 16 (59%) of 27 patients, outward shifting was detected; in eight (30%), inward shifting was detected. In eight patients who underwent temporal lobe resections for drug-resistant epilepsy, shifting was only inward and ranged from 2 to 14 mm (9 mm +/- 3.3). In two of the three patients who underwent burr hole procedures, outward shifting occurred.
Intraoperative DTI can depict shifting of major white matter tracts that is caused by surgical intervention.
前瞻性评估神经外科手术过程中利用扩散张量成像（DTI）对白质束的定位。
获得伦理委员会批准并签署知情同意书。使用一台1.5-T磁共振成像仪，其配备有适配的旋转手术台，放置在射频屏蔽手术室中进行术前和术中成像。对38例接受手术的患者（20例女性患者，18例男性患者；年龄范围7 - 77岁；平均年龄45.6岁）（35例开颅手术和3例钻孔手术）应用具有六个扩散方向的回波平面成像序列进行DTI检查。通过描绘白质束生成分数各向异性的彩色编码图。使用刚性配准算法比较术前和术中图像。
术中DTI在所有患者中技术上可行，感兴趣区域未出现重大图像失真。术前和术中分数各向异性的彩色编码图可以配准；这些图显示神经外科手术过程中白质束有明显且高度可变的移位。在27例接受脑肿瘤切除的患者中，白质束移位范围从向内移位8 mm到向外移位15 mm（平均移位±标准差，向外移位2.5 mm±5.8）。27例患者中有16例（59%）检测到向外移位；8例（30%）检测到向内移位。在8例因耐药性癫痫接受颞叶切除术的患者中，移位仅为向内，范围为2至14 mm（9 mm±3.3）。在3例钻孔手术患者中的2例出现向外移位。
术中DTI能够描绘由手术干预导致的主要白质束移位。
