Skip to main content
SpringerLink
Log in

Technical limitations and pitfalls of diffusion-weighted imaging in intraoperative high-field MRI

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Objective: Image quality in high-field intraoperative MRI (iMRI) is often influenced negatively by susceptibility artifacts. While routine sequences are rather robust, advanced imaging such as diffusion-weighted imaging (DWI) is very sensitive to susceptibility resulting in insufficient imaging data. This study aims to analyze intraoperatively acquired DWI to identify the main factors for susceptibility, to compare results with postoperative images and to identify technical aspects for improvement of intraoperative DWI.

Methods: 100 patients with intraaxial lesions operated in a high-field iMRI were analyzed retrospectively for the quality of intraoperative DWI in comparison to the postoperative scan. General quality of the MR scan, individual diffusion restrictions, artifacts, and their causes were analyzed.

Results: Inclusion criteria were met in 78 patients, 124 diffusion restrictions were included in the comparative analysis. PPV and NPV for the detection of DWI changes intraoperatively were 0.94 and 0.56, respectively (SEN 0.94; SPE 0.56). Image quality was rated significantly (p < 0.0001) worse intraoperatively compared to the postoperative MRI. The main reasons for reduced image quality intraoperatively were air (64%) and artificial material (e.g., compress) (38%) in the resection cavity, as well as positioning of patient’s head outside the MR’s isocenter 37%. Analysis of surgical approaches showed that frontal craniotomies have the highest risk of limited image quality (40%), whereat better results (15% limited image quality) were seen for all other approaches (p = 0.059).

Conclusion: Intraoperative DWI showed reliable results in this analysis. However, image-quality was limited severely in many cases leading to uncertainty in the interpretation. Susceptibility-causing factors might be prevented in many cases, if the surgical team is aware of them. The most important factors are good filling of the resection cavity with irrigation fluid, not placing artificial materials in the resection cavity and adequate positioning of patient’s head according to the MR isocenter.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Roder C, Breitkopf M, Bisdas S, Freitas RS, Dimostheni A, Ebinger M, Wolff M, Tatagiba M, Schuhmann MU (2016) Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery. Neurosurg Focus 40(3):E13. https://doi.org/10.3171/2015.11.focus15530

    Article  PubMed  Google Scholar 

  2. Roder C, Bisdas S, Ebner FH, Honegger J, Naegele T, Ernemann U, Tatagiba M (2014) Maximizing the extent of resection and survival benefit of patients in glioblastoma surgery: High-field iMRI versus conventional and 5-ALA-assisted surgery. Eur J Surg Oncol 40(3):297–304

    Article  CAS  Google Scholar 

  3. Coburger J, Wirtz CR (2018) Fluorescence guided surgery by 5-ALA and intraoperative MRI in high grade glioma: a systematic review. J Neuro-Oncol 141:533–546. https://doi.org/10.1007/s11060-018-03052-4

    Article  CAS  Google Scholar 

  4. Kuhnt D, Bauer MHA, Becker A, Merhof D, Zolal A, Richter M, Grummich P, Ganslandt O, Buchfelder M, Nimsky C (2012) Intraoperative visualization of fiber tracking based reconstruction of language pathways in glioma surgery. Neurosurgery 70(4):911–919; discussion 919-920. https://doi.org/10.1227/NEU.0b013e318237a807

    Article  PubMed  Google Scholar 

  5. Roder C, Bender B, Ritz R, Honegger J, Feigl G, Naegele T, Tatagiba MS, Ernemann U, Bisdas S (2013) Intraoperative visualization of residual tumor: the role of perfusion-weighted imaging in a high-field intraoperative magnetic resonance scanner. Neurosurgery 72:ons151–ons158

    PubMed  Google Scholar 

  6. Roder C, Skardelly M, Ramina KF, Beschorner R, Honneger J, Nägele T, Tatagiba MS, Ernemann U, Bisdas S (2013) Spectroscopy imaging in intraoperative MR suite: tissue characterization and optimization of tumor resection. Int J Comput Assist Radiol Surg 9:551–559. https://doi.org/10.1007/s11548-013-0952-1

    Article  PubMed  Google Scholar 

  7. Nimsky C (2011) Intraoperative acquisition of fMRI and DTI. Neurosurg Clin N Am 22(2):269–277, ix. https://doi.org/10.1016/j.nec.2010.11.005

    Article  PubMed  Google Scholar 

  8. Roder C, Charyasz-Leks E, Breitkopf M, Decker K, Ernemann U, Klose U, Tatagiba M, Bisdas S (2016) Resting-state functional MRI in an intraoperative MRI setting: proof of feasibility and correlation to clinical outcome of patients. J Neurosurg:1–9. https://doi.org/10.3171/2015.7.jns15617

  9. Masuda Y, Akutsu H, Ishikawa E, Matsuda M, Masumoto T, Hiyama T, Yamamoto T, Kohzuki H, Takano S, Matsumura A (2018) Evaluation of the extent of resection and detection of ischemic lesions with intraoperative MRI in glioma surgery: is intraoperative MRI superior to early postoperative MRI? J Neurosurg:1–8. https://doi.org/10.3171/2018.3.JNS172516

  10. Smith JS, Cha S, Mayo MC, McDermott MW, Parsa AT, Chang SM, Dillon WP, Berger MS (2005) Serial diffusion-weighted magnetic resonance imaging in cases of glioma: distinguishing tumor recurrence from postresection injury. J Neurosurg 103(3):428–438. https://doi.org/10.3171/jns.2005.103.3.0428

    Article  PubMed  Google Scholar 

  11. Pala A, Brand C, Kapapa T, Hlavac M, Konig R, Schmitz B, Wirtz CR, Coburger J (2016) The value of intraoperative and early postoperative magnetic resonance imaging in low-grade glioma surgery: a retrospective study. World Neurosurg 93:191–197. https://doi.org/10.1016/j.wneu.2016.04.120

    Article  PubMed  Google Scholar 

  12. Stienen MN, Fierstra J, Pangalu A, Regli L, Bozinov O (2019) The Zurich checklist for safety in the intraoperative magnetic resonance imaging suite: technical note. Oper Neurosurg (Hagerstown) 16(6):756–765. https://doi.org/10.1093/ons/opy205

    Article  Google Scholar 

  13. Reber PJ, Wong EC, Buxton RB, Frank LR (1998) Correction of off resonance-related distortion in echo-planar imaging using EPI-based field maps. Magn Reson Med 39(2):328–330

    Article  CAS  Google Scholar 

  14. Andersson JL, Skare S, Ashburner J (2003) How to correct susceptibility distortions in spin-echo echo-planar images: application to diffusion tensor imaging. Neuroimage 20(2):870–888. https://doi.org/10.1016/s1053-8119(03)00336-7

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany

    Constantin Roder, Patrick Haas & Marcos Tatagiba

  2. Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany

    Ulrike Ernemann & Benjamin Bender

Authors
  1. Constantin Roder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcos Tatagiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrike Ernemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benjamin Bender
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick Haas.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As to the retrospective character of this analysis no specific formal consent was obtained.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roder, C., Haas, P., Tatagiba, M. et al. Technical limitations and pitfalls of diffusion-weighted imaging in intraoperative high-field MRI. Neurosurg Rev 44, 327–334 (2021). https://doi.org/10.1007/s10143-019-01206-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-019-01206-0

Keywords

Search

Navigation