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偕丰隆廉
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1 MRI MRI 2

2 3 I. 4

3 MRI Surgical Strategy Frozen section / 5ALA imri Electrophysiology (MEPetc) /Awake surgery Navigation Microsurgery Safe and maximal resection 5 II. 6

4 MRI 1993 Brigham and Women s Hospital Signa SP GE Signa SP 0.5T T ( T) T Phillips 1.5T T Brainlab, Siemens 1.5T T GE 1.5T T T NTT 0.2T T IMRIS 1.5T GE 1.5T T GE 1.5T Siemens 3T 7 MRI Double donuts (GE,,SignaSP) Pole star (N10, N20) HITACHI Dedicated system BrainSUITE, (APERTO, AIRIS) MRI SIMENS, GE, CROSSTECH PHILIPS, MRI HITACHI 2-room system IMRIS MRI MRI BrainSUITE SIMENS GE PHILIPS 8

5 0.4T 1 room Intelligent Operating Theater (IntelliOpe) 9 0.4T 1 room 10

6 11 0.3T ( ) 1 room anesthesia apparatus 5 gauss line N 12

7 Vesalius CROSS TECH, 0.2T ( )1 room Intra-operative MRI OR1 MRI 13 Brain SUITE SIEMENS, 1.5T 1 room 14

8 15 Phillips, 1.5T 2 room MRI room Operation room Angio. room CT room twin room system located next to the ER 1.5T-MRI ER 16

9 GE, 1.5T 2 room 17 MRI IMRIS Visius Surgical Theater MRI Siemens MRI(1.5T) 2 MRI Brain lab 18

10 19 III. 20

11 MRI( ) Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial Senft et al., Lancet Oncology 2011 Tumor GBM 22 AA 1 Gangliogioma 1 PFS-6 months p=0.046 PFS (days) p=0.083 imri 24 Conve % (16/24) GBM 22 GS 2 AO 1 36% (9/25) MRI level 2 evidence 21 Lt. frontal Oligoastrocytoma (29 M) Preope. imri 3M from OPE 22

12 Brain shift 23 24

13 DBS 25 MRI 26

14 III. MRI MRI 27 MRI MRI MRI MRI 28

15 III. MRI NSF 29 GFR 30mL/min/1.73m2 NSF 5 EMANSF TM TM EOB TM TM TM 30

16 ( TM ) NSF 31 III. MRI 32

17 MRI MRI MRI MRI 33 IV. 34

19 IV

20 IV. MRI3A: B 5 C 5 5 A B 5 C MRI 39 5G MRI Zone A OR Zone B 5G Zone C MRI 5G ZoneC / 40

21 IV. 5 C 5 5MRI 41 IV. 5 C 42

22 IV. 5 C IV. MRI MRI C MRI 44

23 IV. MRI MRI MRI 45 46

24 47 IV. MRI MRI MRI 48

25 MRI MRI Medical Engineer: MRI 49 (page

26 IV. MRI MRI MRI 51 52

27 53 54

28 MRI 55 V. SpO2 MRI 56

29 57 58

30 MRI MRI MRI 59 V. 60

31 T1WI 61 Gd-DTPA MRI MRI(1POD) Gd-DTPA 62

32 MRI OFF 63 64

33 65 66

34 67 V. 68

35 Brain shift MRI 69 Mechanical error 0.1mm Registration error > 1.5-3mm Skin marker 1.5-2mm skin shift 4.2mm Surface 3mm Bone marker 1.4mm (P<0.01) 0.84mm (n=55) SCHICHO: JNS 2007(106)704- Watanabe Radiol Phys Tec2009(2)120- JJSCAS 2005(7) 41- Marker placement unknown 8mm deep area 4mm Brain shift surface Nimsky: Neurosurg2000(47)1070- image distortion > 1-2mm? Manuel: J Neurosurg 2005(103) T1 < T2 ex. 1.5 T MR T2 (max 3.8mm) low field < high field

36 Intraoperative diffusion detected motor fiber. 71 Intraoperative DWI for detection of pyramidal tract DWI Compatible for 0.3Tesl Ozawa: Minim Invasive Neursurg2008a,b Shift after removal4.4mm Ozawa: Neurol Med Chir(Tokyo) 2009 Subcortical stimulation 2.2mm( 0 4.7) mm 5mm Ozawa: Stereotac Func Neurosurg2009 Prabhu: J Neurosurg2011(114)719-7mm+, 13mm- MIkuni: JNS 2007 Kamada JNS2009, Maesawa World NS 2010 amplitude 72

37 73 sylvius IRP Central sulc. SF Precentral sulc. SF 74

38 Wax pile ( 76

39 V. 5 MRI MEP SEP 77 MRI 78

40 V. MRI MRI 79 80

41 V. PDD MRI 81 Impact of the Combination of 5-Aminolevulinic Acid Induced Fluorescence with Intraoperative Magnetic Resonance Imaging Guided Surgery for Glioma Tsugu A, Matsumae M. et al. World Neurosurg. (2011) 76 82

42 MRI

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0386 71.32% 14A 1 (1) (2) (3) 1. (1) 2 (a) (b) (i) (ii) (iii) 3 (iv) (a) (b) (c) (d) 6% 4 2013 3 26 [2013]624 10 5 2013 6 28 [2013]1246 2015 3 [2015]351 0.2 6 [2015]748 180C 7 * * 8 14A (2) 417,800,000