MRI 14 2014.7.12 1 MRI 2
3 I. 4
MRI Surgical Strategy Frozen section / 5ALA imri Electrophysiology (MEPetc) /Awake surgery Navigation Microsurgery Safe and maximal resection 5 II. 6
MRI 1993 Brigham and Women s Hospital Signa SP 1. 2000 GE Signa SP 0.5T 2. 2000 0.3T (2013 0.4T) 3. 2002 0.3T 4. 2006 Phillips 1.5T 5. 2006 0.4T 6. 2006 Brainlab, Siemens 1.5T 7. 2007 0.7T 8. 2008 GE 1.5T 9. 2009 0.3T 10. 2010 0.4T 11. 2011 NTT 0.2T 12. 2012 0.3T 13. 2012 IMRIS 1.5T 14. 2012 GE 1.5T 15. 2013 1.2T 16. 2013 GE 1.5T 17. 2014 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
0.4T 1 room Intelligent Operating Theater (IntelliOpe) 9 0.4T 1 room 10
11 0.3T ( ) 1 room anesthesia apparatus 5 gauss line N 12
Vesalius CROSS TECH, 0.2T ( )1 room Intra-operative MRI OR1 MRI 13 Brain SUITE SIEMENS, 1.5T 1 room 14
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
GE, 1.5T 2 room 17 MRI IMRIS Visius Surgical Theater MRI Siemens MRI(1.5T) 2 MRI Brain lab 18
19 III. 20
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. 25 67% (16/24) GBM 22 GS 2 AO 1 36% (9/25) 226 98 MRI level 2 evidence 21 Lt. frontal Oligoastrocytoma (29 M) Preope. imri 3M from OPE 22
Brain shift 23 24
DBS 25 MRI 26
III. MRI MRI 27 MRI MRI MRI MRI 28
III. MRI NSF 29 GFR 30mL/min/1.73m2 NSF 5 EMANSF TM TM EOB TM TM TM 30
( TM ) NSF 31 III. MRI 32
MRI MRI MRI MRI 33 IV. 34
35 5 5 36
IV. 37 38
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
IV. 5 C 5 5MRI 41 IV. 5 C 42
IV. 5 C 5 5 43 IV. MRI MRI C MRI 44
IV. MRI MRI MRI 45 46
47 IV. MRI MRI MRI 48
MRI MRI Medical Engineer: MRI 49 (page 36-39 50
IV. MRI MRI MRI 51 52
53 54
MRI 55 V. SpO2 MRI 56
57 58
MRI MRI MRI 59 V. 60
T1WI 61 Gd-DTPA MRI MRI(1POD) Gd-DTPA 62
MRI OFF 63 64
65 66
67 V. 68
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)256-70 T1 < T2 ex. 1.5 T MR T2 (max 3.8mm) low field < high field
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) 5.0-18.0mm 5mm Ozawa: Stereotac Func Neurosurg2009 Prabhu: J Neurosurg2011(114)719-7mm+, 13mm- MIkuni: JNS 2007 Kamada JNS2009, Maesawa World NS 2010 amplitude 72
73 sylvius IRP Central sulc. SF Precentral sulc. SF 74
Wax pile ( 76
V. 5 MRI MEP SEP 77 MRI 78
V. MRI MRI 79 80
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
MRI 14 E-mail JSII2014@ml.res.ncc.go.jp 83