Lewin Jonathan S, Nour Sherif Gamal, Meyers Mariana L, Metzger Andrew K, Maciunas Robert J, Wendt Michael, Duerk Jeffrey L, Oppelt Arnulf, Selman Warren R
Department of Radiology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH 44106, USA.
AJR Am J Roentgenol. 2007 Nov;189(5):1096-103. doi: 10.2214/AJR.06.1247.
The objective of our study was to evaluate intraoperative low-field MRI for the frequency and duration of imaging sessions needed during surgery, the direct additional procedure time attributable to imaging, and the proportion of cases in which information provided by intraoperative MRI led to a change in the procedure or otherwise was deemed valuable by operating surgeons.
One hundred twenty-two patients (65 males, 57 females; age range, 6-77 years; mean age, 43.8 years) underwent 130 neurosurgical and ENT procedures (106 craniotomies, 17 transsphenoidal pituitary resections, three biopsies, three intracranial cyst aspirations or injections, and one skull base resection) in a specially designed surgical MRI suite equipped with a 0.2-T imager and a prototype rotating, tiltable surgical table. The intraoperative MR sequences included free induction with steady-state precession (fast imaging with steady-state precession [FISP]), steady-state free precession T2-weighted, reverse fast imaging with steady-state free precession (PSIF), FLASH, spin-echo T1-weighted, turbo spin-echo (TSE) T2-weighted, and TSE FLAIR. Each case was analyzed for the number of imaging sessions, duration of each session, total imaging time during surgery, and impact of imaging information on procedure.
Each patient underwent between one and five intraor postoperative imaging sessions. Imaging times were 1.7 seconds-8 minutes 31 seconds per sequence. The mean total imaging time was 35 minutes 17 seconds per surgical procedure. Imaging was continuous during biopsy and cyst aspiration procedures and averaged 200.67 and 54.66 minutes, respectively. Additional surgical resection based on intraoperative imaging findings was performed in 72.8% of the cases.
Intraoperative low-field MRI provides valuable information for surgical decision making that is predominantly related to detection of residual tumor and the exclusion of complications. The benefits of this technology surpass the time cost associated with its implementation when using proper imaging strategies.
我们研究的目的是评估术中低场强磁共振成像（MRI），包括手术期间所需成像检查的频率和持续时间、归因于成像的直接额外手术时间，以及术中MRI提供的信息导致手术方式改变或以其他方式被手术医生认为有价值的病例比例。
122例患者（65例男性，57例女性；年龄范围6 - 77岁；平均年龄43.8岁）在配备0.2T成像仪和原型旋转、可倾斜手术台的专门设计的手术MRI套件中接受了130例神经外科和耳鼻喉科手术（106例开颅手术、17例经蝶垂体切除术、3例活检、3例颅内囊肿抽吸或注射以及1例颅底切除术）。术中MR序列包括稳态进动自由感应（稳态进动快速成像[FISP]）、稳态自由进动T2加权、稳态自由进动反转快速成像（PSIF）、FLASH、自旋回波T1加权、涡轮自旋回波（TSE）T2加权和TSE FLAIR。分析每个病例的成像检查次数、每次检查的持续时间、手术期间的总成像时间以及成像信息对手术的影响。
每位患者接受了1至5次术中和术后成像检查。每个序列的成像时间为1.7秒至8分31秒。每次手术的平均总成像时间为35分17秒。活检和囊肿抽吸手术期间成像持续进行，平均分别为200.67分钟和54.66分钟。72.8%的病例基于术中成像结果进行了额外的手术切除。
术中低场强MRI为手术决策提供了有价值的信息，主要与残留肿瘤的检测和并发症的排除有关。当采用适当的成像策略时，该技术的益处超过了实施它所带来的时间成本。
