Skip to main content

3 T ioMRI: The Istanbul Experience

  • Chapter
  • First Online:
Book cover Intraoperative Imaging

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 109))

Abstract

Intraoperative imaging technologies have improved surgical results in glioma and pituitary adenoma surgeries. With improvements and refinements 3T intraoperative MRI systems offer a potential of further improving these results. Hereby we describe the equipment and technique of a cost-effective shared-resource 3-T Ultra-high field intraoperative Magnetic Resonance Imaging system and report our continuing experience on surgical tumor resection.

A description of the facility design and equipment are given along with examples from our experience on low-grade gliomas and transsphenoidal surgeries. Our facility based on the twin room concept and uses a 3-T Siemens Trio (Siemens, Erlangen, Germany) scanner. The unit consists of adjacent but independent MRI and operative suites, which are connected by a wide door for ioMRI procedure but are used as conventional MRI and operative units. Rigid head fixation during neurosurgery is achieved with a custom designed 5 pin head-rest which also combines a 4+4 channel head coil. Operation is performed using regular non-MRI compatible equipment and the patient is transferred to the MRI during the procedure using a custom designed floating table. Advanced sequences such as diffusion weighted and diffusion tensor imaging, MR angiography, MR venography, MR spectroscopy can be performed with no changes in the setup and result in image quality comparable to outpatient scans.

The intraoperative 3-T ultra high field MRI unit with the twin room concept permits both diagnostic outpatient imaging and image guided surgery in the same setting and is a cost effective solution to afford a highly capable ioMRI system.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Piepmeier JM (2009) Current concepts in the evaluation and management of WHO grade II gliomas. J Neurooncol 92:253–259

    Article  PubMed  Google Scholar 

  2. Keles GE, Lamborn KR, Berger MS (2001) Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 95:735–745

    Article  PubMed  CAS  Google Scholar 

  3. Sanai N, Berger MS (2008) Glioma extent of resection and its impact on patient outcome. Neurosurgery 62:753–764, Discussion 264–266

    Article  PubMed  Google Scholar 

  4. Schwartz RB, Hsu L, Wong TZ, Kacher DF, Zamani AA, Black PM, Alexander ER, Stieg PE, Moriarty TM, Martin CA, Kikinis R, Jolesz FA (1999) Intraoperative MR imaging guidance for intracranial neurosurgery: experience with the first 200 cases. Radiology 211:477–488

    PubMed  CAS  Google Scholar 

  5. Steinmeier R, Fahlbusch R, Ganslandt O, Nimsky C, Buchfelder M, Kaus M, Heigl T, Lenz G, Kuth R, Huk W (1998) Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report. Neurosurgery 43:739–747, discussion 747–748

    Article  PubMed  CAS  Google Scholar 

  6. Bohinski RJ, Kokkino AK, Warnick RE, Gaskill-Shipley MF, Kormos DW, Lukin RR, Tew JMJ (2001) Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection. Neurosurgery 48:731–742, discussion 742–744

    PubMed  CAS  Google Scholar 

  7. Claus EB, Horlacher A, Hsu L, Schwartz RB, Dello-Iacono D, Talos F, Jolesz FA, Black PM (2005) Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 103:1227–1233

    Article  PubMed  Google Scholar 

  8. Senft C, Seifert V, Hermann E, Franz K, Gasser T (2008) Usefulness of intraoperative ultra low-field magnetic resonance imaging in glioma surgery. Neurosurgery 63:257–266, discussion 266–267

    Article  PubMed  Google Scholar 

  9. Hall WA, Liu H, Martin AJ, Pozza CH, Maxwell RE, Truwit CL (2000) Safety, efficacy, and functionality of high-field strength interventional magnetic resonance imaging for neurosurgery. Neurosurgery 46:632–641, discussion 641–642

    Article  PubMed  CAS  Google Scholar 

  10. Nimsky C, Ganslandt O, Fahlbusch R (2005) Comparing 0.2 tesla with 1.5 tesla intraoperative magnetic resonance imaging analysis of setup, workflow, and efficiency. Acad Radiol 12:1065–1079

    Article  PubMed  Google Scholar 

  11. Kaibara T, Saunders JK, Sutherland GR (1999) Utility of a moveable 1.5 Tesla intraoperative MR imaging system. Can J Neurol Sci 26:313–316

    PubMed  CAS  Google Scholar 

  12. Hatiboglu MA, Weinberg JS, Suki D, Rao G, Prabhu SS, Shah K, Jackson E, Sawaya R (2009) Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery: a prospective volumetric analysis. Neurosurgery 64:1073–1081, discussion 1081

    Article  PubMed  Google Scholar 

  13. Nimsky C, Fujita A, Ganslandt O, Von Keller B, Fahlbusch R (2004) Volumetric assessment of glioma removal by intraoperative high-field magnetic resonance imaging. Neurosurgery 55:358–370, discussion 370–371

    Article  PubMed  Google Scholar 

  14. Hall WA, Galicich W, Bergman T, Truwit CL (2006) 3-Tesla intraoperative MR imaging for neurosurgery. J Neurooncol 77:297–303

    Article  PubMed  Google Scholar 

  15. Pamir MN, Ozduman K, Dincer A, Yildiz E, Peker S, Ozek MM (2009) First intraoperative, shared-resource, ultrahigh-field 3-Tesla magnetic resonance imaging system and its application in low-grade glioma resection. J Neurosurg

    Google Scholar 

  16. 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

    Article  PubMed  CAS  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. McClain CD, Soriano SG, Goumnerova LC, Black PM, Rockoff MA (2007) Detection of unanticipated intracranial hemorrhage during intraoperative magnetic resonance image-guided neurosurgery. Report of two cases. J Neurosurg 106:398–400

    PubMed  Google Scholar 

  19. Nimsky C, Ganslandt O, Hastreiter P, Wang R, Benner T, Sorensen AG, Fahlbusch R (2007) Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery. Neurosurgery 61:178–185, discussion 186

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. 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

    PubMed  CAS  Google Scholar 

  22. Ramina R, Coelho Neto M, Giacomelli A, Barros EJ, Vosgerau R, Nascimento A, Coelho G (2009) Optimizing costs of intraoperative magnetic resonance imaging. A series of 29 glioma cases. Acta Neurochir

    Google Scholar 

  23. Maesawa S, Fujii M, Nakahara N, Watanabe T, Saito K, Kajita Y, Nagatani T, Wakabayashi T, Yoshida J (2009) Clinical indications for high-field 1.5 T intraoperative magnetic resonance imaging and neuro-navigation for neurosurgical procedures. Review of initial 100 cases. Neurol Med Chir (Tokyo) 49:340–349, discussion 349–350

    Article  Google Scholar 

  24. Pamir MN, Ozduman K (2009) 3-T ultrahigh-field intraoperative MRI for low-grade glioma resection. Expert Rev Anticancer Ther 9:1537–1539

    Article  PubMed  Google Scholar 

  25. Ekinci G, Akpinar IN, Baltacioglu F, Erzen C, Kilic T, Elmaci I, Pamir N (2003) Early-postoperative magnetic resonance imaging in glial tumors: prediction of tumor regrowth and recurrence. Eur J Radiol 45:99–107

    Article  PubMed  Google Scholar 

  26. Truwit CL, Hall WA (2006) Intraoperative magnetic resonance imaging-guided neurosurgery at 3-T. Neurosurgery 58:ONS-338–ONS45, discussion ONS-345–ONS-346

    Google Scholar 

  27. McBride DQ, Miller BL, Nikas DL, Buchthal S, Chang L, Chiang F, Booth RA (1995) Analysis of brain tumors using 1H magnetic resonance spectroscopy. Surg Neurol 44:137–144

    Article  PubMed  CAS  Google Scholar 

  28. Duprez TP, Jankovski A, Grandin C, Hermoye L, Cosnard G, Raftopoulos C (2008) Intraoperative 3T MR imaging for spinal cord tumor resection: feasibility, timing, and image quality using a “twin” MR-operating room suite. Am J Neuroradiol 29:1991–1994

    Article  PubMed  CAS  Google Scholar 

  29. Nimsky C, Ganslandt O, Buchfelder M, Fahlbusch R (2006) Intraoperative visualization for resection of gliomas: the role of functional neuronavigation and intraoperative 1.5 T MRI. Neurol Res 28:482–487

    Article  PubMed  Google Scholar 

  30. Ntoukas V, Krishnan R, Seifert V (2008) The new generation polestar n20 for conventional neurosurgical operating rooms: a preliminary report. Neurosurgery 62:82–89, discussion 89–90

    Article  PubMed  Google Scholar 

  31. Kilic T, Ozduman K, Elmaci I, Sav A, Necmettin Pamir M (2002) Effect of surgery on tumor progression and malignant degeneration in hemispheric diffuse low-grade astrocytomas. J Clin Neurosci 9:549–552

    Article  PubMed  Google Scholar 

  32. Kilic T, Ekinci G, Seker A, Elmaci I, Erzen C, Pamir MN (2001) Determining optimal MRI follow-up after transsphenoidal surgery for pituitary adenoma: scan at 24 hours postsurgery provides reliable information. Acta Neurochir 143:1103–1126

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Necmettin Pamir .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag/Wien

About this chapter

Cite this chapter

Pamir, M.N. (2011). 3 T ioMRI: The Istanbul Experience. In: Pamir, M., Seifert, V., Kiris, T. (eds) Intraoperative Imaging. Acta Neurochirurgica Supplementum, vol 109. Springer, Vienna. https://doi.org/10.1007/978-3-211-99651-5_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-211-99651-5_20

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-99650-8

  • Online ISBN: 978-3-211-99651-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics