Gralla Jan, Guzman Raphael, Brekenfeld Caspar, Remonda Luca, Kiefer Claus
Department of Neuroradiology, Inselspital, University of Bern, Switzerland.
J Neurosurg. 2005 Apr;102(4):658-63. doi: 10.3171/jns.2005.102.4.0658.
Conventional imaging for neuronavigation is performed using high-resolution computerized tomography (CT) scanning or a T1-weighted isovoxel magnetic resonance (MR) sequence. The extension of some lesions, however, is depicted much better on T2-weighted MR images. A possible fusion process used to match low-resolution T2-weighted MR image set with a referenced CT or T1-weighted data set leads to poor resolution in the three-dimensional (3D) reconstruction and decreases accuracy, which is unacceptable for neuronavigation. The object of this work was to develop a 3D T2-weighted isovoxel sequence (3D turbo-spin echo [TSE]) for image-guided neuronavigation of the whole brain and to evaluate its clinical application.
The authors performed a phantom study and a clinical trial on a newly developed T2-weighted isovoxel sequence, 3D TSE, for image-guided neuronavigation using a common 1.5-tesla MR imager (Siemens Sonata whole-body imager). The accuracy study and intraoperative image guidance were performed with the aid of the pointer-based Medtronic Stealth Station Treon. The 3D TSE data set was easily applied to the navigational setup and demonstrated a high registration accuracy during the experimental trial and during an initial prospective clinical trial in 25 patients. The sequence displayed common disposable skin fiducial markers and provided convincing delineation of lesions that appear hyperintense on T2-weighted images such as low-grade gliomas and cavernomas in its clinical application.
Three-dimensional TSE imaging broadens the spectrum of navigational and intraoperative data sets, especially for lesions that appear hyperintense on T2-weighted images. The accuracy of its registration is very reliable and it enables high-resolution reconstruction in any orientation, maintaining the advantages of image-guided surgery.
传统的神经导航成像采用高分辨率计算机断层扫描（CT）或T1加权等体素磁共振（MR）序列。然而，某些病变的范围在T2加权MR图像上显示得更好。一种将低分辨率T2加权MR图像集与参考CT或T1加权数据集进行匹配的可能融合过程会导致三维（3D）重建分辨率低下并降低准确性，这对于神经导航而言是不可接受的。本研究的目的是开发一种用于全脑图像引导神经导航的3D T2加权等体素序列（3D快速自旋回波 [TSE]）并评估其临床应用。
作者使用一台普通的1.5特斯拉MR成像仪（西门子索纳塔全身成像仪），对新开发的用于图像引导神经导航的T2加权等体素序列3D TSE进行了模型研究和临床试验。借助基于指针的美敦力Stealth Station Treon进行了准确性研究和术中图像引导。3D TSE数据集很容易应用于导航设置，并在实验试验期间以及在对25例患者进行的初步前瞻性临床试验期间显示出高配准精度。该序列显示了常见的一次性皮肤基准标记，并在其临床应用中对在T2加权图像上呈高信号的病变（如低级别胶质瘤和海绵状血管瘤）提供了令人信服的描绘。
三维TSE成像拓宽了导航和术中数据集的范围，特别是对于在T2加权图像上呈高信号的病变。其配准的准确性非常可靠，并且能够在任何方向上进行高分辨率重建，保持了图像引导手术的优势。
