MRI

142014.7.12

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MRI

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Navigation

Frozen section/ 5ALA

Electrophysiology (MEPetc) /Awake surgeryiMRI

Surgical Strategy

Safe and maximal resection

Microsurgery

MRI

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II.

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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)

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0.4T 1 room

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N

anesthesia apparatus

5 gauss line

0.3T ( ) 1 room

12

CROSS TECH, 0.2T ( )1 room

OR1 MRI

VesaliusIntra-operative MRI

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Brain SUITE SIEMENS, 1.5T 1 room

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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

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MRIIMRIS Visius Surgical Theater

MRISiemens MRI(1.5T)2

MRIBrain lab

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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

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Lt. frontal Oligoastrocytoma(29 M)

Preope.

iMRI

3M from OPE 22

Brain shift

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DBS 25

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MRI

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III.

MRI

MRI

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MRI

MRI

MRI

MRI 28

III.

MRI

NSF

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EMA NSFTM TM

EOB TM

TM TM

GFR 30mL/min/1.73m2

NSF 5

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( TM)

NSF

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III.

MRI

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MRI

MRI

MRI

MRI

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IV.

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MRI 3 A:B 5 C 5

5 A B5

C

MRI39

Zone BZone A

MRI

Zone C5G

OR

5G•• ZoneC• /

5G• MRI•

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IV.5 C

5

5 MRI

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IV.5 C

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IV.5 C

5

5

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IV.

MRI

MRIC

MRI

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IV.

MRI MRI

MRI

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IV.

MRI

MRIMRI

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MRI MRI

Medical Engineer:

MRI49

(page 36-39

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IV.

MRI

MRI

MRI

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MRI

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V.

SpO2MRI

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MRI

MRI

MRI

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T1WI

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Gd-DTPA

MRI MRI(1POD)

Gd-DTPA62

MRI

OFF

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Brain shift

MRI

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• 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.

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• 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-

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73

SF

sylvius

Precentral sulc.

Central sulc.

SF

IRP

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Wax pile (

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V.

5 MRIMEP SEP

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MRI

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V.

MRI

MRI

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PDD

MRI

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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

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MRI

14E-mail JSII2014@ml.res.ncc.go.jp

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