G:G2GWGwG2G MRI /¡ p - jikei.ac.jp · Intraoperative MRI guidance and extent of resection in...
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⾡୰㻹㻾㻵䜺䜲䝗䝷䜲䞁సᡂጤဨ ᪥ᮏ⾡୰⏬ീሗᏛ ⾡୰MRI䜺䜲䝗䝷䜲䞁 ➨14ᅇ᪥ᮏ⾡୰⏬ീሗᏛ 2014.7.12 ᮾி 1 ⾡୰MRIࢻసᡂጤဨ ጤဨ㛗 ᒣ Ꮥṇ ᒣᙧᏛ ⬻⚄⤒እ⛉ ጤဨ㛗 㛵 ὒ ᪩✄⏣Ꮫ ⌮ᕤᏛ⾡㝔 ඛ㐍⌮ᕤᏛ◊✲⛉ ጤဨ㛗 Ỉ㔝 ṇ ᒇᏛ ⬻⚄⤒እ⛉ 㢳ၥ ➃ ኵ ᮐᖠ་⛉Ꮫᩍᤵ 㢳ၥ ⏣ ⣧ ᒇᏛᩍᤵ ጤဨ 㟷ᮌ ⱱᶞ 㡰ኳᇽᏛ ᨺᑕ⥺⛉ ጤဨ 㜿ὠ ༤⩏ ⟃ἼᏛ ⬻⚄⤒እ⛉ ጤဨ Ⲩᕝ ⰾ㍤ ி㒔Ꮫ ⬻⚄⤒እ⛉ ጤဨ ᕷᕝ ᬛ⥅ ᒸᒣᏛ ⬻⚄⤒እ⛉ ጤဨ ᒸ⏣ ṇ⾜ ᒣᙧᏛ 㯞㓉⛉ ጤဨ ⸨ ᘏே ᮾிᏛ ⬻⚄⤒እ⛉ ጤဨ 㰻⸨ ኴ ᮾிዪᏊ་⛉Ꮫ ⬻⚄⤒እ⛉ ጤဨ Ḉ⏣ 㤶 ᒣᙧᏛ ⬻⚄⤒እ⛉ ጤဨ ⏣୰ ಇⱥ ᮾிឿᜨ་⛉Ꮫ ⬻⚄⤒እ⛉ ጤဨ ⏣ᮧ Ꮫ ᮾிዪᏊ་⛉Ꮫ ⬻⚄⤒እ⛉ ጤဨ ⥅῟ ᮾᾏᏛ ⬻⚄⤒እ⛉ ጤဨ ୰ཎ ⣖ඖ ᒇ䝉䞁䝖䝷䝹㝔 ⬻⚄⤒እ⛉ ጤဨ ᡂ⏣ ၿᏕ ᅜ❧䛜䜣◊✲䝉䞁䝍䞊 ⬻⬨㧊⭘⒆⛉ ጤဨ ᖹ㔝 ᏹ 㮵ඣᓥᏛ ⬻⚄⤒እ⛉ ጤဨ ᒣ 㝯ᚿ ᮾிዪᏊ་⛉Ꮫ ⬻⚄⤒እ⛉ ጤဨ ᮧᇉ ၿᾈ ᮾிዪᏊ་⛉Ꮫ ඛ➃⏕་⛉Ꮫ◊✲ᡤ䞉⬻⚄⤒እ⛉ ጤဨ ᳃ᕝ ⱱᘅ ㈡་⛉Ꮫ ศᏊ⚄⤒⛉Ꮫ◊✲䝉䞁䝍䞊䞉㻹㻾་Ꮫ◊✲ศ㔝 ጤဨ ᳃⏣ ኵ ᪥ᮏ་⛉Ꮫ ⬻⚄⤒እ⛉ ጤဨ ⱝᯘ ಇᙪ ᒇᏛ ⬻⚄⤒እ⛉ ጤဨ䞉ᒁ㛗 ⸨ ṇ⣧ ᒇᏛ ⬻⚄⤒እ⛉ ጤဨ䞉ᒁ ⏕⏣ ⪽Ꮚ ᮾிዪᏊ་⛉Ꮫ ⬻⚄⤒እ⛉ 2
Transcript of G:G2GWGwG2G MRI /¡ p - jikei.ac.jp · Intraoperative MRI guidance and extent of resection in...
MRI
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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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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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anesthesia apparatus
5 gauss line
0.3T ( ) 1 room
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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
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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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III.
MRI
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MRI
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III.
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NSF
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EMA NSFTM TM
EOB TM
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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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IV.
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MRI 3 A:B 5 C 5
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MRI39
Zone BZone A
MRI
Zone C5G
OR
5G•• ZoneC• /
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IV.5 C
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5 MRI
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IV.5 C
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IV.5 C
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MRI
MRIC
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IV.
MRI MRI
MRI
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MRI
MRIMRI
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MRI MRI
Medical Engineer:
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(page 36-39
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MRI
MRI
MRI
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MRI
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V.
SpO2MRI
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MRI
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T1WI
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Gd-DTPA
MRI MRI(1POD)
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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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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
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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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