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MRI
142014.7.12
1
MRI
2
3
I.
••
•
4
Navigation
Frozen section/ 5ALA
Electrophysiology (MEPetc) /Awake surgeryiMRI
Surgical Strategy
Safe and maximal resection
Microsurgery
MRI
5
II.
6
MRI1993 Brigham and Women’s Hospital Signa SP
1. 2000 GE Signa SP 0.5T2. 2000 0.3T (2013 0.4T)3. 2002 0.3T4. 2006 Phillips 1.5T5. 2006 0.4T6. 2006 Brainlab, Siemens 1.5T7. 2007 0.7T8. 2008 GE 1.5T9. 2009 0.3T10. 2010 0.4T11. 2011 NTT 0.2T12. 2012 0.3T13. 2012 IMRIS 1.5T14. 2012 GE 1.5T15. 2013 1.2T16. 2013 GE 1.5T17. 2014 Siemens 3T 7
MMRI
Double donuts
(GE,,SignaSP)
Pole star (N10, N20)
HITACHI
(APERTO, AIRIS)
CROSSTECH
Dedicated system MRI
MRI
BrainSUITE,
SIMENS, GE,
PHILIPS,
HITACHI
2--room system MRI
MRI
IMRIS
BrainSUITE
SIMENS
GE
PHILIPS 8
0.4T 1 room
Intelligent Operating Theater (IntelliOpe)
9
0.4T 1 room
10
11
N
anesthesia apparatus
5 gauss line
0.3T ( ) 1 room
12
CROSS TECH, 0.2T ( )1 room
OR1 MRI
VesaliusIntra-operative MRI
13
Brain SUITE SIEMENS, 1.5T 1 room
14
15
Phillips, 1.5T 2 room
• twin room system• located next to the ER• 1.5T-MRI
MRI room Operation roomAngio. room
CT room
ER16
GE, 1.5T 2 room
17
MRIIMRIS Visius Surgical Theater
MRISiemens MRI(1.5T)2
MRIBrain lab
18
19
III.
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Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial Senft et al., Lancet Oncology 2011
MRI ( )
MRI
level 2 evidence
iMRI 24 Conve. 25Tumor GBM 22
AA 1Gangliogioma 1
GBM 22GS 2AO 1
PFS-6 monthsp=0.046
67%(16/24)
36%(9/25)
PFS (days)p=0.083
226 98
21
Lt. frontal Oligoastrocytoma(29 M)
Preope.
iMRI
3M from OPE 22
Brain shift
23
24
DBS 25
•
•
MRI
26
III.
MRI
MRI
27
MRI
MRI
MRI
MRI 28
III.
MRI
NSF
29
EMA NSFTM TM
EOB TM
TM TM
GFR 30mL/min/1.73m2
NSF 5
30
( TM)
NSF
31
III.
MRI
32
MRI
MRI
MRI
MRI
33
IV.
34
35
5
5
36
IV.
37
38
IV.
MRI 3 A:B 5 C 5
5 A B5
C
MRI39
Zone BZone A
MRI
Zone C5G
OR
5G•• ZoneC• /
5G• MRI•
•
40
IV.5 C
5
5 MRI
41
IV.5 C
42
IV.5 C
5
5
43
IV.
MRI
MRIC
MRI
44
IV.
MRI MRI
MRI
45
46
47
IV.
MRI
MRIMRI
48
MRI MRI
Medical Engineer:
MRI49
(page 36-39
50
IV.
MRI
MRI
MRI
51
52
53
54
MRI
55
V.
SpO2MRI
56
57
58
MRI
MRI
MRI
59
V.
60
T1WI
61
Gd-DTPA
MRI MRI(1POD)
Gd-DTPA62
MRI
OFF
63
64
65
66
67
V.
68
Brain shift
MRI
69
• Mechanical error 0.1mm• Registration error > 1.5-3mm
– Skin marker 1.5-2mm → skin shift 4.2mm– Surface 3mm– Bone marker 1.4mm (P<0.01)
0.84mm (n=55)
Marker placement unknown
JJSCAS 2005(7) 41-
Watanabe RadiolPhys Tec2009(2)120-
SCHICHO: JNS 2007(106)704-
• Brain shift surface 8mmdeep area 4mm
Nimsky: Neurosurg2000(47)1070-
• image distortion > 1-2mm?– T1 < T2 ex. 1.5 T MR T2 (max 3.8mm) low field < high field
Manuel: J Neurosurg 2005(103)256-70
Intraoperative diffusion detected motor fiber.
71
• DWI Compatible for 0.3Tesl
• Shift after removal4.4mm
• Subcortical stimulation 2.2mm( 0 4.7)5.0-18.0mm
Intraoperative DWI for detection of pyramidal tract
5mmOzawa: Stereotac Func Neurosurg2009
Ozawa: Minim Invasive Neursurg2008a,b
Ozawa: Neurol Med Chir(Tokyo) 2009
Prabhu: J Neurosurg2011(114)719-
amplitudeKamada JNS2009, Maesawa World NS 2010
MIkuni: JNS 20077mm+, 13mm-
72
73
SF
sylvius
Precentral sulc.
Central sulc.
SF
IRP
74
Wax pile (
76
V.
5 MRIMEP SEP
77
•
•
•
MRI
78
V.
MRI
MRI
79
80
V.
PDD
MRI
81
Impact of the Combination of 5-Aminolevulinic Acid–Induced Fluorescence with Intraoperative Magnetic Resonance Imaging–Guided Surgery for GliomaTsugu A, Matsumae M. et al. World Neurosurg. (2011) 76
82