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Initial Experience with Using a Structured Light 3D Scanner and Image Registration to Plan Bedside Subdural Evacuating Port System Placement.
Bow H, Yang X, Chotai S, Feldman M, Yu H, Englot DJ, Miga MI, Pruthi S, Dawant BM, Parker SL
(2020) World Neurosurg 137: 350-356
MeSH Terms: Craniotomy, Hematoma, Subdural, Chronic, Humans, Imaging, Three-Dimensional, Models, Anatomic, Neuronavigation, Neurosurgical Procedures, Printing, Three-Dimensional, Tomography, X-Ray Computed
Show Abstract · Added March 30, 2020
BACKGROUND - Chronic subdural hematoma evacuation can be achieved in select patients through bedside placement of the Subdural Evacuation Port System (SEPS; Medtronic, Inc., Dublin, Ireland). This procedure involves drilling a burr hole at the thickest part of the hematoma. Identifying this location is often difficult, given the variable tilt of available imaging and distant anatomic landmarks. This paper evaluates the feasibility and accuracy of a bedside navigation system that relies on visible light-based 3-dimensional (3D) scanning and image registration to a pre-procedure computed tomography scan. The information provided by this system may increase accuracy of the burr hole location.
METHODS - In Part 1, the accuracy of this system was evaluated using a rigid 3D printed phantom head with implanted fiducials. In Part 2, the navigation system was tested on 3 patients who underwent SEPS placement.
RESULTS - The error in registration of this system was less than 2.5 mm when tested on a rigid 3D printed phantom head. Fiducials located in the posterior aspect of the head were difficult to reliably capture. For the 3 patients who underwent 5 SEPS placements, the distance between anticipated SEPS burr hole location based on registration and actual burr hole location was less than 1cm.
CONCLUSIONS - A bedside cranial navigation system based on 3D scanning and image registration has been introduced. Such a system may increase the success rate of bedside procedures, such as SEPS placement. However, technical challenges such as the ability to scan hair and practical challenges such as minimization of patient movement during scans must be overcome.
Copyright © 2020 Elsevier Inc. All rights reserved.
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9 MeSH Terms
Rapid whole-brain quantitative magnetization transfer imaging using 3D selective inversion recovery sequences.
Cronin MJ, Xu J, Bagnato F, Gochberg DF, Gore JC, Dortch RD
(2020) Magn Reson Imaging 68: 66-74
MeSH Terms: Adult, Algorithms, Brain, Brain Mapping, Computer Simulation, Echo-Planar Imaging, Female, Healthy Volunteers, Humans, Image Processing, Computer-Assisted, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Male, Models, Theoretical, Myelin Sheath, Reproducibility of Results, White Matter
Show Abstract · Added March 18, 2020
Selective inversion recovery (SIR) is a quantitative magnetization transfer (qMT) method that provides estimates of parameters related to myelin content in white matter, namely the macromolecular pool-size-ratio (PSR) and the spin-lattice relaxation rate of the free pool (R), without the need for independent estimates of ∆B, B, and T. Although the feasibility of performing SIR in the human brain has been demonstrated, the scan times reported previously were too long for whole-brain applications. In this work, we combined optimized, short-TR acquisitions, SENSE/partial-Fourier accelerations, and efficient 3D readouts (turbo spin-echo, SIR-TSE; echo-planar imaging, SIR-EPI; and turbo field echo, SIR-TFE) to obtain whole-brain data in 18, 10, and 7 min for SIR-TSE, SIR-EPI, SIR-TFE, respectively. Based on numerical simulations, all schemes provided accurate parameter estimates in large, homogenous regions; however, the shorter SIR-TFE scans underestimated focal changes in smaller lesions due to blurring. Experimental studies in healthy subjects (n = 8) yielded parameters that were consistent with literature values and repeatable across scans (coefficient of variation: PSR = 2.2-6.4%, R = 0.6-1.4%) for all readouts. Overall, SIR-TFE parameters exhibited the lowest variability, while SIR-EPI parameters were adversely affected by susceptibility-related image distortions. In patients with relapsing remitting multiple sclerosis (n = 2), focal changes in SIR parameters were observed in lesions using all three readouts; however, contrast was reduced in smaller lesions for SIR-TFE, which was consistent with the numerical simulations. Together, these findings demonstrate that efficient, accurate, and repeatable whole-brain SIR can be performed using 3D TFE, EPI, or TSE readouts; however, the appropriate readout should be tailored to the application.
Copyright © 2020 Elsevier Inc. All rights reserved.
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17 MeSH Terms
Resting-State SEEG May Help Localize Epileptogenic Brain Regions.
Goodale SE, González HFJ, Johnson GW, Gupta K, Rodriguez WJ, Shults R, Rogers BP, Rolston JD, Dawant BM, Morgan VL, Englot DJ
(2020) Neurosurgery 86: 792-801
MeSH Terms: Adult, Brain, Brain Mapping, Cohort Studies, Electroencephalography, Epilepsies, Partial, Female, Humans, Imaging, Three-Dimensional, Male, Middle Aged, Neurosurgical Procedures, Rest, Stereotaxic Techniques
Show Abstract · Added March 18, 2020
BACKGROUND - Stereotactic electroencephalography (SEEG) is a minimally invasive neurosurgical method to localize epileptogenic brain regions in epilepsy but requires days in the hospital with interventions to trigger several seizures.
OBJECTIVE - To make initial progress in the development of network analysis methods to identify epileptogenic brain regions using brief, resting-state SEEG data segments, without requiring seizure recordings.
METHODS - In a cohort of 15 adult focal epilepsy patients undergoing SEEG, we evaluated functional connectivity (alpha-band imaginary coherence) across sampled regions using brief (2 min) resting-state data segments. Bootstrapped logistic regression was used to generate a model to predict epileptogenicity of individual regions.
RESULTS - Compared to nonepileptogenic structures, we found increased functional connectivity within epileptogenic regions (P < .05) and between epileptogenic areas and other structures (P < .01, paired t-tests, corrected). Epileptogenic areas also demonstrated higher clustering coefficient (P < .01) and betweenness centrality (P < .01), and greater decay of functional connectivity with distance (P < .05, paired t-tests, corrected). Our functional connectivity model to predict epileptogenicity of individual regions demonstrated an area under the curve of 0.78 and accuracy of 80.4%.
CONCLUSION - Our study represents a preliminary step towards defining resting-state SEEG functional connectivity patterns to help localize epileptogenic brain regions ahead of neurosurgical treatment without requiring seizure recordings.
Copyright © 2019 by the Congress of Neurological Surgeons.
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14 MeSH Terms
A comparison of thin-plate spline deformation and finite element modeling to compensate for brain shift during tumor resection.
Frisken S, Luo M, Juvekar P, Bunevicius A, Machado I, Unadkat P, Bertotti MM, Toews M, Wells WM, Miga MI, Golby AJ
(2020) Int J Comput Assist Radiol Surg 15: 75-85
MeSH Terms: Brain Neoplasms, Finite Element Analysis, Humans, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Neuronavigation, Neurosurgical Procedures, Retrospective Studies, Ultrasonography
Show Abstract · Added March 30, 2020
PURPOSE - Brain shift during tumor resection can progressively invalidate the accuracy of neuronavigation systems and affect neurosurgeons' ability to achieve optimal resections. This paper compares two methods that have been presented in the literature to compensate for brain shift: a thin-plate spline deformation model and a finite element method (FEM). For this comparison, both methods are driven by identical sparse data. Specifically, both methods are driven by displacements between automatically detected and matched feature points from intraoperative 3D ultrasound (iUS). Both methods have been shown to be fast enough for intraoperative brain shift correction (Machado et al. in Int J Comput Assist Radiol Surg 13(10):1525-1538, 2018; Luo et al. in J Med Imaging (Bellingham) 4(3):035003, 2017). However, the spline method requires no preprocessing and ignores physical properties of the brain while the FEM method requires significant preprocessing and incorporates patient-specific physical and geometric constraints. The goal of this work was to explore the relative merits of these methods on recent clinical data.
METHODS - Data acquired during 19 sequential tumor resections in Brigham and Women's Hospital's Advanced Multi-modal Image-Guided Operating Suite between December 2017 and October 2018 were considered for this retrospective study. Of these, 15 cases and a total of 24 iUS to iUS image pairs met inclusion requirements. Automatic feature detection (Machado et al. in Int J Comput Assist Radiol Surg 13(10):1525-1538, 2018) was used to detect and match features in each pair of iUS images. Displacements between matched features were then used to drive both the spline model and the FEM method to compensate for brain shift between image acquisitions. The accuracies of the resultant deformation models were measured by comparing the displacements of manually identified landmarks before and after deformation.
RESULTS - The mean initial subcortical registration error between preoperative MRI and the first iUS image averaged 5.3 ± 0.75 mm. The mean subcortical brain shift, measured using displacements between manually identified landmarks in pairs of iUS images, was 2.5 ± 1.3 mm. Our results showed that FEM was able to reduce subcortical registration error by a small but statistically significant amount (from 2.46 to 2.02 mm). A large variability in the results of the spline method prevented us from demonstrating either a statistically significant reduction in subcortical registration error after applying the spline method or a statistically significant difference between the results of the two methods.
CONCLUSIONS - In this study, we observed less subcortical brain shift than has previously been reported in the literature (Frisken et al., in: Miller (ed) Biomechanics of the brain, Springer, Cham, 2019). This may be due to the fact that we separated out the initial misregistration between preoperative MRI and the first iUS image from our brain shift measurements or it may be due to modern neurosurgical practices designed to reduce brain shift, including reduced craniotomy sizes and better control of intracranial pressure with the use of mannitol and other medications. It appears that the FEM method and its use of geometric and biomechanical constraints provided more consistent brain shift correction and better correction farther from the driving feature displacements than the simple spline model. The spline-based method was simpler and tended to give better results for small deformations. However, large variability in the spline results and relatively small brain shift prevented this study from demonstrating a statistically significant difference between the results of the two methods.
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9 MeSH Terms
Hierarchical spherical deformation for cortical surface registration.
Lyu I, Kang H, Woodward ND, Styner MA, Landman BA
(2019) Med Image Anal 57: 72-88
MeSH Terms: Algorithms, Anatomic Landmarks, Brain Mapping, Datasets as Topic, Humans, Image Enhancement, Image Processing, Computer-Assisted, Imaging, Three-Dimensional, Magnetic Resonance Imaging
Show Abstract · Added January 31, 2020
We present hierarchical spherical deformation for a group-wise shape correspondence to address template selection bias and to minimize registration distortion. In this work, we aim at a continuous and smooth deformation field to guide accurate cortical surface registration. In conventional spherical registration methods, a global rigid alignment and local deformation are independently performed. Motivated by the composition of precession and intrinsic rotation, we simultaneously optimize global rigid rotation and non-rigid local deformation by utilizing spherical harmonics interpolation of local composite rotations in a single framework. To this end, we indirectly encode local displacements by such local composite rotations as functions of spherical locations. Furthermore, we introduce an additional regularization term to the spherical deformation, which maximizes its rigidity while reducing registration distortion. To improve surface registration performance, we employ the second order approximation of the energy function that enables fast convergence of the optimization. In the experiments, we validate our method on healthy normal subjects with manual cortical surface parcellation in registration accuracy and distortion. We show an improved shape correspondence with high accuracy in cortical surface parcellation and significantly low registration distortion in surface area and edge length. In addition to validation, we discuss parameter tuning, optimization, and implementation design with potential acceleration.
Copyright © 2019 Elsevier B.V. All rights reserved.
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9 MeSH Terms
Computational Fluid Dynamics Analysis of Surgical Approaches to Bilateral Vocal Fold Immobility.
Rios G, Morrison RJ, Song Y, Fernando SJ, Wootten C, Gelbard A, Luo H
(2020) Laryngoscope 130: E57-E64
MeSH Terms: Computer Simulation, Female, Humans, Hydrodynamics, Imaging, Three-Dimensional, Vocal Cord Paralysis
Show Abstract · Added July 30, 2020
OBJECTIVES - Bilateral vocal fold immobility (BVFI) is a rare and life-threatening condition in which both vocal folds are fixed, resulting in airway obstruction associated with life-threatening respiratory compromise. Treatment of BVFI is largely surgical and remains an unsatisfactory compromise between voice, breathing, and swallowing. No comparisons between currently employed techniques currently exist. We sought to employ computational fluid dynamics (CFD) modeling to delineate the optimal surgical approach for BVFI.
METHODS - Utilizing clinical computed tomography of BVFI subjects, coupled with image analytics employing CFD models and subject pulmonary function data, we compared the airflow features in the baseline pathologic states and changes seen between endoscopic cordotomy, endoscopic suture lateralization, and posterior cricoid expansion.
RESULTS - CFD modeling demonstrated that the greatest airflow velocity occurs through the posterior glottis on inspiration and anterior glottis on expiration in both the normal condition and in BVFI. Glottic airflow velocity and resistance were significantly higher in the BVFI condition compared to normal. Geometric indices (cross-sectional area of airway) were lower in posterior cricoid expansion surgery when compared to alternate surgical approaches. CFD measures (airflow velocity and resistance) improved with all surgical approaches but were superior with posterior cricoid expansion.
CONCLUSION - CFD modeling can provide discrete, quantitative assessment of the airflow through the laryngeal inlet, and offers insights into the pathophysiology and changes that occur after surgery for BVFI.
LEVEL OF EVIDENCE - NA. Laryngoscope, 130:E57-E64, 2020.
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
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6 MeSH Terms
Diffusion tensor tractography to visualize axonal outgrowth and regeneration in a 4-cm reverse autograft sciatic nerve rabbit injury model.
Farinas AF, Pollins AC, Stephanides M, O'Neill D, Al-Kassis S, Esteve IVM, Colazo JM, Keller PR, Rankin T, Wormer BA, Kaoutzanis C, Dortch RD, Thayer WP
(2019) Neurol Res 41: 257-264
MeSH Terms: Animals, Axons, Diffusion Tensor Imaging, Imaging, Three-Dimensional, Nerve Regeneration, Peripheral Nerve Injuries, Rabbits, Sciatic Nerve, Transplantation, Autologous
Show Abstract · Added November 7, 2019
BACKGROUND - Diffusion tensor tractography (DTT) has recently been shown to accurately detect nerve injury and regeneration. This study assesses whether 7-tesla (7T) DTT imaging is a viable modality to observe axonal outgrowth in a 4 cm rabbit sciatic nerve injury model fixed by a reverse autograft (RA) surgical technique.
METHODS - Transection injury of unilateral sciatic nerve (4 cm long) was performed in 25 rabbits and repaired using a RA surgical technique. Analysis of the nerve autograft was performed at 3, 6, and 11 weeks postoperatively and compared to normal contralateral sciatic nerve, used as control group. High-resolution DTT from ex vivo sciatic nerves were obtained using 3D diffusion-weighted spin-echo acquisitions at 7-T. Total axons and motor and sensory axons were counted at defined lengths along the graft.
RESULTS - At 11 weeks, histologically, the total axon count of the RA group was equivalent to the contralateral uninjured nerve control group. Similarly, by qualitative DTT visualization, the 11-week RA group showed increased fiber tracts compared to the 3 and 6 weeks counterparts. Upon immunohistochemical evaluation, 11-week motor axon counts did not significantly differ between RA and control; but significantly decreased sensory axon counts remained. Nerves explanted at 3 weeks and 6 weeks showed decreased motor and sensory axon counts.
DISCUSSION - 7-T DTT is an effective imaging modality that may be used qualitatively to visualize axonal outgrowth and regeneration. This has implications for the development of technology that non-invasively monitors peripheral nerve regeneration in a variety of clinical settings.
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MeSH Terms
Integrative radiomics expression predicts molecular subtypes of primary clear cell renal cell carcinoma.
Yin Q, Hung SC, Rathmell WK, Shen L, Wang L, Lin W, Fielding JR, Khandani AH, Woods ME, Milowsky MI, Brooks SA, Wallen EM, Shen D
(2018) Clin Radiol 73: 782-791
MeSH Terms: Biomarkers, Tumor, Carcinoma, Renal Cell, Contrast Media, Humans, Imaging, Three-Dimensional, Kidney Neoplasms, Magnetic Resonance Imaging, Multimodal Imaging, Neoplasm Grading, Neoplasm Staging, Positron-Emission Tomography, Retrospective Studies
Show Abstract · Added October 30, 2019
AIM - To identify combined positron-emission tomography (PET)/magnetic resonance imaging (MRI)-based radiomics as a surrogate biomarker of intratumour disease risk for molecular subtype ccA and ccB in patients with primary clear cell renal cell carcinoma (ccRCC).
MATERIALS AND METHODS - PET/MRI data were analysed retrospectively from eight patients. One hundred and sixty-eight radiomics features for each tumour sampling based on the regionally sampled tumours with 23 specimens were extracted. Sparse partial least squares discriminant analysis (SPLS-DA) was applied to feature screening on high-throughput radiomics features and project the selected features to low-dimensional intrinsic latent components as radiomics signatures. In addition, multilevel omics datasets were leveraged to explore the complementing information and elevate the discriminative ability.
RESULTS - The correct classification rate (CCR) for molecular subtype classification by SPLS-DA using only radiomics features was 86.96% with permutation test p=7×10. When multi-omics datasets including mRNA, microvascular density, and clinical parameters from each specimen were combined with radiomics features to refine the model of SPLS-DA, the best CCR was 95.65% with permutation test, p<10; however, even in the case of generating the classification based on transcription features, which is the reference standard, there is roughly 10% classification ambiguity. Thus, this classification level (86.96-95.65%) of the proposed method represents the discriminating level that is consistent with reality.
CONCLUSION - Featured with high accuracy, an integrated multi-omics model of PET/MRI-based radiomics could be the first non-invasive investigation for disease risk stratification and guidance of treatment in patients with primary ccRCC.
Published by Elsevier Ltd.
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MeSH Terms
Venous Thromboembolism during Interventional MRI-Guided Stereotactic Surgery.
Kundishora AJ, Englot DJ, Starr PA, Martin AJ, Larson PS
(2018) Stereotact Funct Neurosurg 96: 40-45
MeSH Terms: Adolescent, Adult, Aged, Child, Female, Humans, Imaging, Three-Dimensional, Intraoperative Complications, Magnetic Resonance Imaging, Interventional, Male, Middle Aged, Retrospective Studies, Risk Factors, Stereotaxic Techniques, Venous Thromboembolism, Young Adult
Show Abstract · Added September 25, 2018
BACKGROUND/AIMS - Interventional MRI (iMRI) allows real-time confirmation of electrode and microcatheter location in anesthetized patients; however, MRI-compatible pneumatic compression devices (PCD) to reduce the periprocedural venous thromboembolism (VTE) risk are not commercially available. Given the paucity of literature on VTE following iMRI surgery, better characterizing patients suffering this complication and the incidence of this event following iMRI procedures is pivotal for defining best surgical practices. We aim to investigate the incidence of postoperative VTE in iMRI procedures without the use of PCD.
METHODS - Medical records and operative times of patients were retrospectively reviewed. Patient demographics and mean surgical durations were reported with statistical comparisons via ANOVA and the 2-tailed Student t test, an α of 0.05, and the Bonferroni correction. Patients experiencing postoperative VTE underwent an in-depth chart review.
RESULTS - Two out of two hundred ten (0.95%) iMRI procedures resulted in postoperative VTE events. There were statistically significant differences in procedure times between unilateral electrode (157.5 ± 5.7 min), bilateral electrode (193.6 ± 2.9 min), and bilateral gene therapy procedures (467.3 ± 26.5 min). Both patients had longer-than-average operative times for their respective procedures.
CONCLUSIONS - The incidence of postoperative VTE is low following iMRI procedures, even without the use of PCD during surgery.
© 2018 S. Karger AG, Basel.
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16 MeSH Terms
A modern epilepsy surgery treatment algorithm: Incorporating traditional and emerging technologies.
Englot DJ
(2018) Epilepsy Behav 80: 68-74
MeSH Terms: Algorithms, Drug Resistant Epilepsy, Electroencephalography, Epilepsy, Epilepsy, Generalized, Humans, Imaging, Three-Dimensional, Minimally Invasive Surgical Procedures, Quality of Life, Radiosurgery, Treatment Outcome
Show Abstract · Added September 25, 2018
Epilepsy surgery has seen numerous technological advances in both diagnostic and therapeutic procedures in recent years. This has increased the number of patients who may be candidates for intervention and potential improvement in quality of life. However, the expansion of the field also necessitates a broader understanding of how to incorporate both traditional and emerging technologies into the care provided at comprehensive epilepsy centers. This review summarizes both old and new surgical procedures in epilepsy using an example algorithm. While treatment algorithms are inherently oversimplified, incomplete, and reflect personal bias, they provide a general framework that can be customized to each center and each patient, incorporating differences in provider opinion, patient preference, and the institutional availability of technologies. For instance, the use of minimally invasive stereotactic electroencephalography (SEEG) has increased dramatically over the past decade, but many cases still benefit from invasive recordings using subdural grids. Furthermore, although surgical resection remains the gold-standard treatment for focal mesial temporal or neocortical epilepsy, ablative procedures such as laser interstitial thermal therapy (LITT) or stereotactic radiosurgery (SRS) may be appropriate and avoid craniotomy in many cases. Furthermore, while palliative surgical procedures were once limited to disconnection surgeries, several neurostimulation treatments are now available to treat eloquent cortical, bitemporal, and even multifocal or generalized epilepsy syndromes. An updated perspective in epilepsy surgery will help guide surgical decision making and lay the groundwork for data collection needed in future studies and trials.
Copyright © 2018 Elsevier Inc. All rights reserved.
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11 MeSH Terms