The Use of Diffusion Tensor Imaging in Neuronavigation during Brain Tumor Surgery: Case Reports

Česká verzia

Authors: A. Zolal ¹; M. Sameš ¹; P. Vachata ¹; R. Bartoš ¹; M. Nováková ²; M. Derner ²
Authors place of work: Neurochirurgické oddělení Masarykovy nemocnice, Ústí nad Labem ¹; Radiodiagnostické oddělení Masarykovy nemocnice, Ústí nad Labem ²
Published in the journal: Cesk Slov Neurol N 2008; 71/104(3): 352-357
Category: Case Report

Summary

Aim:
The aim of this work is to describe a procedure for visualization of the white matter fiber tracts with the use of DTI (Diffusion Tensor Imaging), the use of the reconstructed image data in neuronavigation, and to document the clinical relevance of the method.

Materials and methods:
This paper contains descriptions of two cases of patients with supratentorial tumorous lesion, where tractography results were used intraoperatively. A procedure that was previously described in literature, using the applications Volume One and dTV, was used for the fiber-tracking and for the import into the neuronavigation system. Resulting fiber tracts were voxelized and fused with the non-diffusion weighted dataset (b = 0 s/mm²), the fused images were imported into the neuronavigation and registered with the anatomical datasets.

Results:
In both cases, clinically relevant neural tracts were successfully reconstructed with the use of the described method, and the reconstructed images were imported into the neuronavigation system. The optimal trajectory and extent of the resection could be planned with the use of the neuronavigation, respecting the course of the displayed fiber tracts in the vicinity of the resected lesion.

Conclusion:
The results of DTI tractography can be reliably integrated into the neuronavigation system using the described method. The use of tractography is beneficial for the optimal planning of the surgical trajectory and the extent of the resection.

Key words:
DTI – tractography – neuronavigation– neural tracts – brain tumours

Zdroje

1. Basser PJ, Mattiello J, LeBihan D. MR diffusion tensor spectroscopy and imaging. Biophys J 1994; 66(1): 259–267.

2. Lazar M, Weinstein DM, Tsuruda JS, Hasan KM, Arfanakis K, Meyerand ME et al. White matter tractography using diffusion tensor deflection. Hum Brain Mapp 2003; 18(4): 306–321.

3. Mori S, Crain BJ, Chacko VP, van Zijl PC. Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 1999; 45(2): 265–269.

4. Merhof D, Richter M, Enders F, Hastreiter P, Ganslandt O, Buchfelder M et al. Fast and accurate connectivity analysis between functional regions based on DT-MRI. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv 2006; 9 (Pt 2): 225–233.

5. Inoue T, Shimizu H, Yoshimoto T. Imaging the pyramidal tract in patients with brain tumors. Clin Neurol Neurosurg 1999; 101(1): 4–10.

6. Coenen VA, Krings T, Mayfrank L, Polin RS, Reinges MH, Thron A et al. Three-dimensional visualization of the pyramidal tract in a neuronavigation system during brain tumor surgery: first experiences and technical note. Neurosurgery 2001; 49(1): 86–92.

7. Kamada K, Houkin K, Takeuchi F, Ishii N, Ikeda J, Sawamura Y et al. Visualization of the eloquent motor system by integration of MEG, functional, and anisotropic diffusion-weighted MRI in functional neuronavigation. Surg Neurol 2003; 59(5): 352–361.

8. Nimsky C, Ganslandt O, Merhof D, Sorensen AG, Fahlbusch R. Intraoperative visualization of the pyramidal tract by diffusion-tensor-imaging-based fiber tracking. Neuroimage 2006; 30(4): 1219–1229.

9. Berman JI, Berger MS, Chung SW, Nagarajan SS, Henry RG. Accuracy of diffusion tensor magnetic resonance imaging tractography assessed using intraoperative subcortical stimulation mapping and magnetic source imaging. J Neurosurg 2007; 107(3): 488–494.

10. Kamada K, Todo T, Masutani Y, Aoki S, Ino K, Morita A et al. Visualization of the frontotemporal language fibers by tractography combined with functional magnetic resonance imaging and magnetoencephalography. J Neurosurg 2007; 106(1): 90–98.

11. Kamada K, Todo T, Morita A, Masutani Y, Aoki S, Ino K et al. Functional monitoring for visual pathway using real-time visual evoked potentials and optic-radiation tractography. Neurosurgery 2005; 57(Suppl): 121–127.

12. Stefan H, Nimsky C, Scheler G, Rampp S, Hopfengartner R, Hammen T et al. Periventricular nodular heterotopia: A challenge for epilepsy surgery. Seizure 2007; 16(1): 81–86.

13. Masutani Y, Aoki S, Abe O, Hayashi N, Otomo K. MR diffusion tensor imaging: recent advance and new techniques for diffusion tensor visualization. Eur J Radiol 2003; 46(1): 53–66.

14. Nimsky C, Ganslandt O, Fahlbusch R. Implementation of fiber tract navigation. Neurosurgery 2006; 58(Suppl): 292–303.

15. Dauguet J, Peled S, Berezovskii V, Delzescaux T, Warfield SK, Born R et al. Comparison of fiber tracts derived from in-vivo DTI tractography with 3D histological neural tract tracer reconstruction on a macaque brain. Neuroimage 2007; 37(2): 530–538.