Dual-room 1.5-T intraoperative magnetic resonance imaging suite with a movable magnet: implementation and preliminary experience

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We hereby report our initial clinical experience of a dual-room intraoperative magnetic resonance imaging (iMRI) suite with a movable 1.5-T magnet for both neurosurgical and independent diagnostic uses. The findings from the first 45 patients who underwent scheduled neurosurgical procedures with iMRI in this suite (mean age, 41.3 ± 12.0 years; intracranial tumors, 39 patients; cerebral vascular lesions, 5 patients; epilepsy surgery, 1 patient) were reported. The extent of resection depicted at intraoperative imaging, the surgical consequences of iMRI, and the clinical practicability of the suite were analyzed. Fourteen resections with a trans-sphenoidal/transoral approach and 31 craniotomies were performed. Eighty-two iMRI examinations were performed in the operating room, while during the same period of time, 430 diagnostic scans were finished in the diagnostic room. In 22 (48.9%) of 45 patients, iMRI revealed accessible residual tumors leading to further resection. No iMRI-related adverse event occurred. Complete lesion removal was achieved in 36 (80%) of all 45 cases. It is concluded that the dual-room 1.5-T iMRI suite can be successfully integrated into standard neurosurgical workflow. The layout of the dual-room suite can enable the maximum use of the system and save costs by sharing use of the 1.5-T magnet between neurosurgical and diagnostic use. Intraoperative MR imaging may provide valuable information that allows intraoperative modification of the surgical strategy.

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  1. 1.

    Alexander AL, Lee JE, Wu YC, Field AS (2006) Comparison of diffusion tensor imaging measurements at 3.0 T versus 1.5 T with and without parallel imaging. Neuroimaging Clin N Am 16:299–309, xi

  2. 2.

    Ardekani S, Sinha U (2005) Geometric distortion correction of high-resolution 3 T diffusion tensor brain images. Magn Reson Med 54:1163–1171

  3. 3.

    Black PM, Moriarty T, Alexander E, Stieg P, Woodard EJ, Gleason PL, Martin CH, Kikinis R, Schwartz RB, Jolesz FA (1997) Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications. Neurosurgery 41:831–842, discussion 842–845

  4. 4.

    Bohinski RJ, Warnick RE, Gaskill-Shipley MF, Zuccarello M, van LHR, Kormos DW, Tew JM Jr (2001) Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery 49:1133–1143, discussion 1143–1144

  5. 5.

    Bradley WG (2002) Achieving gross total resection of brain tumors: intraoperative MR imaging can make a big difference. AJNR Am J Neuroradiol 23:348–349

  6. 6.

    Chen X, Weigel D, Ganslandt O, Buchfelder M, Nimsky C (2007) Diffusion tensor imaging and white matter tractography in patients with brainstem lesions. Acta Neurochir (Wien) 149:1117–1131, discussion 1131

  7. 7.

    Chen X, Weigel D, Ganslandt O, Buchfelder M, Nimsky C (2009) Prediction of visual field deficits by diffusion tensor imaging in temporal lobe epilepsy surgery. NeuroImage 45:286–297

  8. 8.

    Chen X, Weigel D, Ganslandt O, Fahlbusch R, Buchfelder M, Nimsky C (2007) Diffusion tensor-based fiber tracking and intraoperative neuronavigation for the resection of a brainstem cavernous angioma. Surg Neurol 68:285–291, discussion 291

  9. 9.

    Darakchiev BJ, Tew JM Jr, Bohinski RJ, Warnick RE (2005) Adaptation of a standard low-field (0.3-T) system to the operating room: focus on pituitary adenomas. Neurosurg Clin N Am 16:155–164

  10. 10.

    Dort JC, Sutherland GR (2001) Intraoperative magnetic resonance imaging for skull base surgery. Laryngoscope 111:1570–1575

  11. 11.

    Dorward NL, Alberti O, Velani B, Gerritsen FA, Harkness WF, Kitchen ND, Thomas DG (1998) Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation. J Neurosurg 88:656–662

  12. 12.

    Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimsky C (2001) Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 95:381–390

  13. 13.

    Fahlbusch R, Keller B, Ganslandt O, Kreutzer J, Nimsky C (2005) Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging. Eur J Endocrinol 153:239–248

  14. 14.

    Fujiwara N, Sakatani K, Katayama Y, Murata Y, Hoshino T, Fukaya C, Yamamoto T (2004) Evoked-cerebral blood oxygenation changes in false-negative activations in BOLD contrast functional MRI of patients with brain tumors. NeuroImage 21:1464–1471

  15. 15.

    Ganslandt O, Fahlbusch R, Nimsky C, Kober H, Moller M, Steinmeier R, Romstock J, Vieth J (1999) Functional neuronavigation with magnetoencephalography: outcome in 50 patients with lesions around the motor cortex. Neurosurg Focus 6:e3

  16. 16.

    Gerlach R, de Rochemont RdM, Gasser T, Marquardt G, Reusch J, Imoehl L, Seifert V (2008) Feasibility of Polestar N20, an ultra-low-field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas: lessons learned from the first 40 cases. Neurosurgery 63:272–284, discussion 284–285

  17. 17.

    Hadani M, Spiegelman R, Feldman Z, Berkenstadt H, Ram Z (2001) Novel, compact, intraoperative magnetic resonance imaging-guided system for conventional neurosurgical operating rooms. Neurosurgery 48:799–807, discussion 807–809

  18. 18.

    Hoult DI, Saunders JK, Sutherland GR, Sharp J, Gervin M, Kolansky HG, Kripiakevich DL, Procca A, Sebastian RA, Dombay A, Rayner DL, Roberts FA, Tomanek B (2001) The engineering of an interventional MRI with a movable 1.5 Tesla magnet. J Magn Reson Imaging 13:78–86

  19. 19.

    Jankovski A, Francotte F, Vaz G, Fomekong E, Duprez T, Van Boven M, Docquier MA, Hermoye L, Cosnard G, Raftopoulos C (2008) Intraoperative magnetic resonance imaging at 3-T using a dual independent operating room–magnetic resonance imaging suite: development, feasibility, safety, and preliminary experience. Neurosurgery 63:412–424, discussion 424–426

  20. 20.

    Kanner AA, Vogelbaum MA, Mayberg MR, Weisenberger JP, Barnett GH (2002) Intracranial navigation by using low-field intraoperative magnetic resonance imaging: preliminary experience. J Neurosurg 97:1115–1124

  21. 21.

    Kollias SS, Bernays R, Marugg RA, Romanowski B, Yonekawa Y, Valavanis A (1998) Target definition and trajectory optimization for interactive MR-guided biopsies of brain tumors in an open configuration MRI system. J Magn Reson Imaging 8:143–159

  22. 22.

    Martin AJ, Hall WA, Liu H, Pozza CH, Michel E, Casey SO, Maxwell RE, Truwit CL (2000) Brain tumor resection: intraoperative monitoring with high-field-strength MR imaging-initial results. Radiology 215:221–228

  23. 23.

    Nimsky C, Ganslandt O, Cerny S, Hastreiter P, Greiner G, Fahlbusch R (2000) Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging. Neurosurgery 47:1070–1079, discussion 1079–1080

  24. 24.

    Nimsky C, Ganslandt O, Kober H, Buchfelder M, Fahlbusch R (2001) Intraoperative magnetic resonance imaging combined with neuronavigation: a new concept. Neurosurgery 48:1082–1089, discussion 1089–1091

  25. 25.

    Nimsky C, Ganslandt O, Kober H, Moller M, Ulmer S, Tomandl B, Fahlbusch R (1999) Integration of functional magnetic resonance imaging supported by magnetoencephalography in functional neuronavigation. Neurosurgery 44:1249–1255, discussion 1255–1256

  26. 26.

    Nimsky C, Ganslandt O, Tomandl B, Buchfelder M, Fahlbusch R (2002) Low-field magnetic resonance imaging for intraoperative use in neurosurgery: a 5-year experience. Eur Radiol 12:2690–2703

  27. 27.

    Nimsky C, Ganslandt O, von KB, Fahlbusch R (2006) Intraoperative high-field MRI: anatomical and functional imaging. Acta Neurochir Suppl 98:87–95

  28. 28.

    Nimsky C, Ganslandt O, Von Keller B, Romstock J, Fahlbusch R (2004) Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients. Radiology 233:67–78

  29. 29.

    Nimsky C, von KB, Ganslandt O, Fahlbusch R (2006) Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery 59:105–114, discussion 105–114

  30. 30.

    Pamir MN, Ozduman K, Dincer A, Yildiz E, Peker S, Ozek MM (2010) First intraoperative, shared-resource, ultrahigh-field 3-Tesla magnetic resonance imaging system and its application in low-grade glioma resection. J Neurosurg 112:57–69

  31. 31.

    Pamir MN, Peker S, Ozek MM, Dincer A (2006) Intraoperative MR imaging: preliminary results with 3 Tesla MR system. Acta Neurochir Suppl 98:97–100

  32. 32.

    Pergolizzi RS Jr, Nabavi A, Schwartz RB, Hsu L, Wong TZ, Martin C, Black PM, Jolesz FA (2001) Intra-operative MR guidance during trans-sphenoidal pituitary resection: preliminary results. J Magn Reson Imaging 13:136–141

  33. 33.

    Roberts DW, Hartov A, Kennedy FE, Miga MI, Paulsen KD (1998) Intraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases. Neurosurgery 43:749–758, discussion 758–760

  34. 34.

    Roessler K, Ungersboeck K, Czech T, Aichholzer M, Dietrich W, Goerzer H, Matula C, Koos WT (1997) Contour-guided brain tumor surgery using a stereotactic navigating microscope. Stereotact Funct Neurosurg 68:33–38

  35. 35.

    Salas S, Brimacombe M, Schulder M (2007) Stereotactic accuracy of a compact intraoperative MRI system. Stereotact Funct Neurosurg 85:69–74

  36. 36.

    Schenck JF, Jolesz FA, Roemer PB, Cline HE, Lorensen WE, Kikinis R, Silverman SG, Hardy CJ, Barber WD, Laskaris ET et al (1995) Superconducting open-configuration MR imaging system for image-guided therapy. Radiology 195:805–814

  37. 37.

    Schulder M, Salas S, Brimacombe M, Fine P, Catrambone J, Maniker AH, Carmel PW (2006) Cranial surgery with an expanded compact intraoperative magnetic resonance imager. Technical note. J Neurosurg 104:611–617

  38. 38.

    Staubert A, Pastyr O, Echner G, Oppelt A, Vetter T, Schlegel W, Bonsanto MM, Tronnier VM, Kunze S, Wirtz CR (2000) An integrated head-holder/coil for intraoperative MRI in open neurosurgery. J Magn Reson Imaging 11:564–567

  39. 39.

    Sutherland GR, Kaibara T, Louw D, Hoult DI, Tomanek B, Saunders J (1999) A mobile high-field magnetic resonance system for neurosurgery. J Neurosurg 91:804–813

  40. 40.

    Truwit CL, Hall WA (2006) Intraoperative magnetic resonance imaging-guided neurosurgery at 3-T. Neurosurgery 58:ONS-338-45, discussion ONS-345-6

  41. 41.

    Wagner W, Tschiltschke W, Niendorf WR, Schroeder HW, Gaab MR (1997) Infrared-based neuronavigation and cortical motor stimulation in the management of central-region tumors. Stereotact Funct Neurosurg 68:112–116

  42. 42.

    Zimmermann M, Seifert V, Trantakis C, Raabe A (2001) Open MRI-guided microsurgery of intracranial tumours in or near eloquent brain areas. Acta Neurochir (Wien) 143:327–337

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We would like to thank Professor Rudolf Fahlbusch, Professor Christopher Nimsky, and the Erlangen iMRI team for their pioneering and innovative works on intraoperative imaging and functional neuronavigation. Our study was inspired and guided by their valuable experiences! We also thank Dr. Dong Wang (Department of Radiology, Chinese PLA General Hospital) for technical support of this project. This study was supported by the National Natural Science Foundation of China (NSFC 30800349) and the Science and Technology Planning Project of Guangdong Province, China (2008B030301077).


The authors have no personal financial or institutional interest in any of the drugs, materials, or devices in this article.

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Correspondence to Bai-nan Xu.

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Rudolf Fahlbusch, Hannover, Germany

The authors describe their experience with IOP 1.5-T MRI gained within two (!) months in 45 patients. After the implementation of functional MRI and 1.5-T MRI in Erlangen in 2002, the authors have adopted the Erlangen concept and protocol. However, by using a movable rotating table, they changed the magnet concept from a patient-to-magnet system to a magnet-to-patient system working with a movable magnet (the ceiling-mounted IMRIS system). This allows an easier management of a hybrid room for therapeutic as well as for diagnostic (outpatient) procedures. On the other hand, the IMRIS system has the “disadvantage” of a longer transportation time and is still lacking an integrated automatic registration within the head fixation and coil. In more than half of the authors’ patients, mainly in those with gliomas and pituitary adenomas, the IOP strategy was modified: In 60% of pituitary adenomas, well-resectable tumors could be removed completely with the aid of IOP MRI. In well-resectable gliomas, they improved from 30% to 75%, although the first examination showed that the degree of resection was unsatisfactory in 70%. All our data that are based on our long-lasting learning curve with surgical and surgical + iop MRI experiences, including our present experience at the International Neuroscience Institute Hannover, yield better results: in 45% unsatisfactory resection rate in gliomas and 35% in pituitary adenomas. The authors could confirm this trend during their oral presentation given in January 2011 at the Intraoperative Imaging Congress in Zürich. They have to be congratulated on their impressively large series of meanwhile over 450 patients. These experiences demonstrate how important iop MRI has become for ALL NEUROSURGEONS working with brain tumors.

Christopher Nimsky, Marburg, Germany

Intraoperative magnetic resonance (MR) imaging, pioneered with low-field MR systems over 15 years ago, has gained increasing acceptance. Still, however, there is no definite optimal solution how the best intraoperative surgical workflow can be combined with the best economical use of such a system. This paper reports the preliminary experience of a dual-room high-field MR concept using a ceiling-mounted movable magnet, allowing intraoperative use parallel to diagnostic imaging. Due to economical constraints, such dual-use systems have been preferred by several sites in the last years, either as in this paper or in a solution of an OR adjacent to the diagnostic room and moving the patient during surgery (e.g., Miyabi concept). When choosing an intraoperative MRI system, two other major decisions have to be made: the decision for the field strength—either low-field magnets (nowadays mostly 0.15-T systems) or high-field magnets ranging from 1.5 to 3 T, where the image quality and the full spectrum of MRI diagnostic tools favor the high-field systems. On the other hand, until now, there is no clear decision whether 3-T systems have a distinctive benefit over the 1.5-T systems for the intraoperative situation, which would be expected seeing their increasing use in the diagnostic situation. Another important point in choosing the right system is the efficient integration of the surgical workflow with close navigation integration so that the intraoperative images can be used intraoperatively without much complicated efforts and so that efficient and precise intraoperative updates of the navigational data are possible. Despite all progress, still there is not an ideal solution; however, the increasing number of users of such systems will hopefully give the industry the input to develop more efficient solutions in the future.

Jizong Zhao, Beijing, China

Chen et al. provided a comprehensive description of their early experience with a dual-room 1.5-T intraoperative magnetic resonance imaging (iMRI) unit with a movable magnet. They addressed important considerations including room layout, safety, ergonomics, surgical instrumentation, anesthesia modifications, and imaging protocol design. In doing so, they provided general insight into the multitude of factors that must be weighed for institutions considering new iMRI installations. With this suite, surgeons can operate without any constraints in terms of equipment (although an MRI-compatible head holder is needed). To achieve intraoperative imaging, a movable magnet is transferred via ceiling-mounted tracks to the operating room without moving the patient. Most of the time, the scanner is used for diagnostic imaging and thereby becomes a revenue source for the hospital.

The authors also summarized their initial experience with iMRI for a variety of intracranial pathological lesions including gliomas, pituitary adenomas, and cerebral vascular diseases. Although the cohort of patients is small and their experience is preliminary, they reported that iMRI led to intraoperative modification of surgical strategy (further resection) in 22 patients (48.9%), which is consistent with previously reported literatures. With their illustrative cases, the authors also demonstrated that 1.5-T iMRI enhances the spectrum of intraoperative imaging capabilities, extending to areas such as diffusion tensor imaging, fiber tracking, real-time navigation, and vascular imaging. Besides the numbers of surgical procedures, they reported 430 diagnostic scans in the diagnostic room of the suite, which means, with the dual-room design, that sharing use of the magnet and smooth surgical workflow can be achieved. It is very important because the most useful iMRI system should be the one that gets the most use. The higher fixed costs of the magnet and installation may increase the motivation for shared usage, which maximizes the opportunity to increase revenue from non-operative scanning.

Current data demonstrate that this system generates reliable information about the extent of tumor resection in high-grade as well as in low-grade gliomas. Still, to promote iMRI and to eventually establish it as a standard of care, the promise of the technology must first be proven. Chen et al. should be encouraged to investigate the long-term outcome of a larger cohort of patients operated with this system. It will also be very interesting to analyze the learning curve and more detailed cost-effective ratio of the system in the long run.

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Chen, X., Xu, B., Meng, X. et al. Dual-room 1.5-T intraoperative magnetic resonance imaging suite with a movable magnet: implementation and preliminary experience. Neurosurg Rev 35, 95–110 (2012) doi:10.1007/s10143-011-0336-3

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  • Dual-room magnetic resonance imaging suite
  • Intraoperative magnetic resonance imaging
  • Neuronavigation