School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Department of Neurosurgery, King's College Hospital, London, UK.
Eur Radiol. 2023 Nov;33(11):8067-8076. doi: 10.1007/s00330-023-09736-4. Epub 2023 Jun 17.
Surgical planning of vestibular schwannoma surgery would benefit greatly from a robust method of delineating the facial-vestibulocochlear nerve complex with respect to the tumour. This study aimed to optimise a multi-shell readout-segmented diffusion-weighted imaging (rs-DWI) protocol and develop a novel post-processing pipeline to delineate the facial-vestibulocochlear complex within the skull base region, evaluating its accuracy intraoperatively using neuronavigation and tracked electrophysiological recordings.
In a prospective study of five healthy volunteers and five patients who underwent vestibular schwannoma surgery, rs-DWI was performed and colour tissue maps (CTM) and probabilistic tractography of the cranial nerves were generated. In patients, the average symmetric surface distance (ASSD) and 95% Hausdorff distance (HD-95) were calculated with reference to the neuroradiologist-approved facial nerve segmentation. The accuracy of patient results was assessed intraoperatively using neuronavigation and tracked electrophysiological recordings.
Using CTM alone, the facial-vestibulocochlear complex of healthy volunteer subjects was visualised on 9/10 sides. CTM were generated in all 5 patients with vestibular schwannoma enabling the facial nerve to be accurately identified preoperatively. The mean ASSD between the annotators' two segmentations was 1.11 mm (SD 0.40) and the mean HD-95 was 4.62 mm (SD 1.78). The median distance from the nerve segmentation to a positive stimulation point was 1.21 mm (IQR 0.81-3.27 mm) and 2.03 mm (IQR 0.99-3.84 mm) for the two annotators, respectively.
rs-DWI may be used to acquire dMRI data of the cranial nerves within the posterior fossa.
Readout-segmented diffusion-weighted imaging and colour tissue mapping provide 1-2 mm spatially accurate imaging of the facial-vestibulocochlear nerve complex, enabling accurate preoperative localisation of the facial nerve. This study evaluated the technique in 5 healthy volunteers and 5 patients with vestibular schwannoma.
• Readout-segmented diffusion-weighted imaging (rs-DWI) with colour tissue mapping (CTM) visualised the facial-vestibulocochlear nerve complex on 9/10 sides in 5 healthy volunteer subjects. • Using rs-DWI and CTM, the facial nerve was visualised in all 5 patients with vestibular schwannoma and within 1.21-2.03 mm of the nerve's true intraoperative location. • Reproducible results were obtained on different scanners.
对于前庭神经鞘瘤手术的外科规划而言，如果有一种强大的方法可以根据肿瘤情况对面神经-前庭耳蜗神经复合体进行描绘，将大有益处。本研究旨在优化一种多壳层读出分段扩散加权成像(rs-DWI)方案，并开发一种新的后处理管道，以描绘颅底区域内的面神经-前庭耳蜗复合体，通过神经导航和跟踪的电生理记录在术中评估其准确性。
在一项针对 5 名健康志愿者和 5 名接受前庭神经鞘瘤手术的患者的前瞻性研究中，进行了 rs-DWI，并生成了彩色组织图(CTM)和颅神经概率追踪图。在患者中，参照神经放射科医生批准的面神经分割，计算平均对称表面距离(ASSD)和 95%豪斯多夫距离(HD-95)。使用神经导航和跟踪的电生理记录评估患者结果的术中准确性。
仅使用 CTM，就可以在 10 个侧面中的 9 个面上可视化健康志愿者受试者的面神经-前庭耳蜗复合体。在所有 5 例前庭神经鞘瘤患者中均生成了 CTM，从而能够在术前准确识别面神经。两位注释者的分割之间的平均 ASSD 为 1.11mm(SD 0.40)，平均 HD-95 为 4.62mm(SD 1.78)。从神经分割到阳性刺激点的中位数距离为 1.21mm(1QR 0.81-3.27mm)和 2.03mm(1QR 0.99-3.84mm)，分别为两位注释者。
rs-DWI 可用于获取后颅窝颅神经的弥散张量成像(dMRI)数据。
读出分段扩散加权成像(rs-DWI)和彩色组织图(CTM)提供了 1-2mm 的面神经-前庭耳蜗神经复合体的空间精确成像，从而能够对面神经进行准确的术前定位。本研究在 5 名健康志愿者和 5 名前庭神经鞘瘤患者中评估了该技术。
• rs-DWI 联合 CTM 可在 5 名健康志愿者的 10 个侧面中的 9 个侧面上可视化面神经-前庭耳蜗神经复合体。• 使用 rs-DWI 和 CTM，在 5 例前庭神经鞘瘤患者中均可以可视化面神经，并与神经的真实术中位置相差 1.21-2.03mm。• 在不同的扫描仪上获得了可重复的结果。
