Grasso Erica, Certo Francesco, Ganau Mario, Bonomo Giulio, Fiumanò Giuseppa, Buscema Giovanni, Maugeri Andrea, Agodi Antonella, Barbagallo Giuseppe M V
Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Neurological Surgery, Policlinico "G. Rodolico-San Marco" University Hospital, University of Catania, 95124 Catania, Italy.
Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, 95124 Catania, Italy.
Brain Sci. 2024 Dec 31;15(1):35. doi: 10.3390/brainsci15010035.
: Elastic image fusion (EIF) using an intraoperative CT (iCT) scan may enhance neuronavigation accuracy and compensate for brain shift. : To evaluate the safety and reliability of the EIF algorithm (Virtual iMRI Cranial 4.5, Brainlab AG, Munich Germany, for the identification of residual tumour in glioblastoma surgery. Moreover, the impact of brain shift on software reliability is assessed. : This ambispective study included 80 patients with a diagnosis of glioblastoma. Pre-operative MRI was elastically fused with an intraoperative CT scan (BodyTom; Samsung-Neurologica, Danvers, MA, USA) acquired at the end of the resection. Diagnostic specificity and the sensitivity of each tool was determined. The impact of brain shift on residual tumour was statistically analysed. An analysis of accuracy was performed through Target Registration Error (TRE) measurement after rigid image fusion (RIF) and EIF. A qualitative evaluation of each Virtual MRI image (VMRI) was performed. : VMRI identified residual tumour in 26/80 patients (32.5%), confirmed by post-operative MRI (true positive). Of these, 5 cases were left intentionally due to DES-positive responses, 8 cases underwent near maximal or subtotal resection, and 13 cases were not detected by iCT. However, in the other 27/80 cases (33.8%), VMRI reported residual tumour that was present neither on iCT nor on post-operative MRI (false positive). i-CT showed a sensitivity of 56% and specificity of 100%; VMRI demonstrated a sensitivity of 100% and specificity of 50%. Spearman correlation analysis showed a moderate correlation between pre-operative volume and VMRI tumour residual. Moreover, tumour involving insula or infiltrating more than one lobe displayed higher median values ( = 0.023) of virtual residual tumour. A statistically significant reduction towards lower TRE values after EIF was observed for test structures. : Virtual iMRI was proven to be a feasible option to detect residual tumour. Its integration within a multimodal imaging protocol may provide neurosurgeons with intraoperatively updated imaging.
使用术中CT（iCT）扫描进行弹性图像融合（EIF）可提高神经导航准确性并补偿脑移位。为评估EIF算法（Virtual iMRI Cranial 4.5，德国慕尼黑Brainlab AG公司）在胶质母细胞瘤手术中识别残留肿瘤的安全性和可靠性。此外，还评估了脑移位对软件可靠性的影响。这项双盲研究纳入了80例诊断为胶质母细胞瘤的患者。术前MRI与切除结束时获取的术中CT扫描（BodyTom；美国马萨诸塞州丹弗斯的三星神经逻辑公司）进行弹性融合。确定了每种工具的诊断特异性和敏感性。对脑移位对残留肿瘤的影响进行了统计学分析。在刚性图像融合（RIF）和EIF后，通过目标配准误差（TRE）测量进行准确性分析。对每个虚拟MRI图像（VMRI）进行了定性评估。VMRI在26/80例患者（32.5%）中识别出残留肿瘤，术后MRI证实（真阳性）。其中，5例因DES阳性反应而有意保留，8例接受了近全切除或次全切除，13例未被iCT检测到。然而，在其他27/80例（33.8%）病例中，VMRI报告的残留肿瘤在iCT和术后MRI上均未出现（假阳性）。i-CT的敏感性为56%，特异性为100%；VMRI的敏感性为100%，特异性为50%。Spearman相关性分析显示术前体积与VMRI肿瘤残留之间存在中度相关性。此外，累及岛叶或浸润多个脑叶的肿瘤显示虚拟残留肿瘤的中位数较高（=0.023）。观察到测试结构在EIF后TRE值向更低值有统计学显著降低。虚拟iMRI被证明是检测残留肿瘤的可行选择。将其整合到多模态成像方案中可为神经外科医生提供术中更新的成像。
