Currently, magnetic resonance imaging(MRI) is the only imaging modality available which is capable of acquiring intra-operative images frequently with acceptable spatial and contrast resolution. However, the incorpora...Currently, magnetic resonance imaging(MRI) is the only imaging modality available which is capable of acquiring intra-operative images frequently with acceptable spatial and contrast resolution. However, the incorporation of MRI technology into the operating room requires special anesthetic considerations. It may include various aspects such as transport, remote location anesthesia, strong electromagnetic field, use of approved items, equipment counts, possible emergencies, and surgery in awake patients. The patient safety may be compromised by health-related, equipment-related, and procedure-related risks. Direct patient observation may be compromised by acoustic noise, darkened environment, obstructed line of sight, and distractions along with difficult access to the patient for airway management. Most often, the patient's head will be 180° away from the anesthesiologist during the procedure. Several monitors exist that are designed for conditional use in a MR environment. The general design criterion in these monitors is to eliminate conductors that carry electrical signals for monitoring physiologic parameters of the patient. General anesthesia requires an extended anesthetic circuit for ventilation maintenance and drug administration because the patient is located farther from the anesthesia machine than in traditional operating room settings. Dead space creates a time delay before the volatile anesthetic and drugs are administered and when expected effects can be observed. Therefore, the attending anaesthesiologists must understand the above aspects for safe conduct of neurosurgical procedures by minimizing MRI associated accidents while assuring optimal patient vigilance.展开更多
Background Intraoperative magnetic resonance imaging （iMRI） dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI （〈1.0T）. This paper reports the clinical experien...Background Intraoperative magnetic resonance imaging （iMRI） dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI （〈1.0T）. This paper reports the clinical experience with a 3T iMRI-integrated neurosurgical suite in Huashan Hospital, Shanghai, China. Methods From September 2010 through March 2012, 373 consecutive patients underwent neurological surgery under guidance with 3T iMRI. A retrospective analysis was conducted regarding clinical efficiency. Results All surgery in the 373 patients was safe. The ratio of gross total resection for cerebral gliomas （n=161） was increased from 55.90% to 87.58%. The ratio of benefit in extent of resection was 39.13%. One hundred and fifty eight of the 161 glioma patients accomplished follow-up at 3 months postoperatively. Twenty of 161 patients （12.42%） suffered from early motor deficit after surgery. Late motor deficit was however observed in five of 158 patients （3.16%）. Twenty-one of 161 patients （13.04%） had early speech deficit and late speech deficit was only observed in six of 158 patients （3.80%）. The ratio of gross total resection for pituitary adenomas （n=49） was increased from 77.55% to 85.71%. The ratio of benefit in extent of resection was 10.2%. There were no iMRI-related adverse events even for patients who underwent awake craniotomy. Conclusion The 3T iMRI integrated neurosurgical suite provides high-quality intraoperative structural and functional imaging for real-time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.展开更多
The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors...The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been in-troduced, including an operating microscope in the late 1950 s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging(DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging(DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resec-tion cavity and thus overcome this remaining uncer-tainty of intraoperative MRI in high grade brain tumor resection.展开更多
The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the detection of metastases.I...The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the detection of metastases.In particular,contrast enhanced ultrasonography(CEUS)allows the display of the parenchymal microvasculature,enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases,which is similar to contrast-enhanced computed tomography(CT)and contrast-enhanced magnetic resonance imaging.Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US.Furthermore,studies have shown that CEUS yields sensitivities comparable to CT.In this review,we describe the state of the art of CEUS for detecting colorectal liver metastases,the imaging features,the literature reports of metastases in CEUS as well as its technique,its clinical role and its potential applications.Additionally,the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.展开更多
Objective: To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating ...Objective: To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Methods: Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative“visu-alization”of surrounding eloquent structures,“brain shift”corrections, and navigational plan updates. Results: All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative “brain shift” severely deterred locating of the lesions;however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Conclusions: Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.展开更多
AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospe...AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospective analyzed.The sensitivity,specificity,false negative and false positive rates of contrast enhanced magnetic resonance imaging(CE-MRI),IOUS and CEIOUS were calculated and compared.Surgical strategy changes due to CE-IOUS were analyzed.RESULTS:Lesions detected by CE-MRI,IOUS and CEIOUS were 60,97 and 85 respectively.The sensitivity,specificity,false negative rate,false positive rate of CEMRI were 98.2%,98.6%,98.6%,60.0%,respectively;for IOUS were 50.0%,90.9%,1.8%,1.4%,respectively;and for CE-IOUS were 1.4%,40.0%,50.0%,9.1%,respectively.The operation strategy of 9(9/50,18.0%) cases was changed according to the results of CE-IOUS.CONCLUSION:Compared with CE-MRI,CE-IOUS performs better in detection and differentiation of small metastasis and regenerative nodules.It plays an important role in the decision-making of HCC operation.展开更多
Arteriovenous malformations(AVMs)are vascularabnormalities that consist of multiple fistulousconnections between arteries and veins without the normalintervening capillary bed.Microsurgical resection is
目的探讨氢质子磁共振波谱(proton magnetic resonance spectroscopy,1H-MRS)联合术中磁共振(in-traoperative magnetic resonance imaging,iMRI)导航在颅内病变穿刺活检的应用。方法使用兼具有1H-MRS功能的1.5 T术中磁共振系统,并配有...目的探讨氢质子磁共振波谱(proton magnetic resonance spectroscopy,1H-MRS)联合术中磁共振(in-traoperative magnetic resonance imaging,iMRI)导航在颅内病变穿刺活检的应用。方法使用兼具有1H-MRS功能的1.5 T术中磁共振系统,并配有导航计算机成像系统。26例颅内病变患者,先使用1H-MRS分析病灶组织生化及代谢情况,然后在iMRI导航引导下根据病变不同部位代谢情况对病变相应区域进行穿刺活检。结果 26例患者穿刺成功,25例病变组织获得组织病理学诊断。所有病例术中及术后均未出现明显并发症如严重出血、新发神经功能障碍等。结论 1H-MRS分析能提供病变的代谢信息,并帮助确定最佳活检取材点,iMRI导航能精确定位,并在术中明确取材位置和排除出血等并发症,1H-MRS联合iMRI导航在颅内病变活检是一种精准、有效、安全的技术。展开更多
目的评价3.0 T术中磁共振成像(intraoperative magnetic resonance imaging,iMRI)联合弥散张量成像(diffusion tensor imaging,DTI)锥体束示踪导航及术中神经电生理监测(intraoperative neurophysiologicalmonitoring,IONM)技术在各种...目的评价3.0 T术中磁共振成像(intraoperative magnetic resonance imaging,iMRI)联合弥散张量成像(diffusion tensor imaging,DTI)锥体束示踪导航及术中神经电生理监测(intraoperative neurophysiologicalmonitoring,IONM)技术在各种累及岛叶的胶质瘤切除手术中的应用价值。方法 2010年9月至2011年6月以3.0 T iMRI数字一体化神经外科手术中心为平台,在iMRI功能导航结合IONM下对18例累及岛叶的胶质瘤实施切除手术。其中对10例主侧半球肿瘤采用唤醒麻醉下术中直接皮质电刺激进行语言区定位。对所有18例岛叶胶质瘤,术中均采用DTI导航结合术中连续经皮质刺激运动诱发电位和皮质下电刺激进行锥体束定位。结果通过iMRI实时扫描,18例患者中有13例发现肿瘤残留,其中6例在iMRI实时影像导航下获得了进一步切除,使肿瘤的影像学全切除率从5/18提高至9/18。经Fisher检验,iMRI前、后的肿瘤切除率(包括全切除及次全切除)具有统计学意义(P=0.046)。9例因DTI导航或IONM提示切缘临近功能皮质或深部锥体束,而未强求全切除。10例主侧半球肿瘤患者中,术后近期(1周内)出现一过性语言功能障碍5例,随访至术后1个月,语言功能均恢复到术前水平或以上;18例患者中3例术后近期出现肢体运动功能障碍,随访至术后1个月,其中2例完全恢复。总体术后1个月的神经功能障碍仅1例。无iMRI及IONM相关的并发症发生。结论应用3.0 T iMRI术中实时影像导航联合DTI锥体束示踪成像技术及IONM技术有助于最大程度地安全切除岛叶胶质瘤。展开更多
目的术中磁共振成像(intraoperative Magnetic Resonance Imaging,iMRI)系统是近年来日渐兴起的先进神经外科手术辅助设备,在垂体腺瘤的微侵袭手术中起到关键作用。文中探讨运用iMRI辅助大型侵袭性垂体腺瘤手术的临床应用价值。方法大...目的术中磁共振成像(intraoperative Magnetic Resonance Imaging,iMRI)系统是近年来日渐兴起的先进神经外科手术辅助设备,在垂体腺瘤的微侵袭手术中起到关键作用。文中探讨运用iMRI辅助大型侵袭性垂体腺瘤手术的临床应用价值。方法大型侵袭性垂体腺瘤患者20例,男8例,女12例,经鼻-蝶肿瘤切除术18例,开颅肿瘤切除术2例,均在iMRI系统辅助下行肿瘤显微切除术。术中行MRI扫描1～2次。若术中扫描提示肿瘤残留,则借助iMRI定位并指导手术再次切除残余肿瘤。结果 iMRI扫描发现肿瘤残留者8例,其中6例(30%)做进一步切除;经iMRI再次扫描证实其中4例达全切除,另2例达次全切除;最终16例肿瘤获全切除,4例肿瘤达次全切除,肿瘤的全切率由60%提高至80%,未发现与iMRI相关的并发症。结论 iMRI能有效判断垂体腺瘤的切除程度,为手术结果的实时判断提供客观依据,从而在提高手术精确性和安全性的同时,提高了肿瘤的全切率。展开更多
文摘Currently, magnetic resonance imaging(MRI) is the only imaging modality available which is capable of acquiring intra-operative images frequently with acceptable spatial and contrast resolution. However, the incorporation of MRI technology into the operating room requires special anesthetic considerations. It may include various aspects such as transport, remote location anesthesia, strong electromagnetic field, use of approved items, equipment counts, possible emergencies, and surgery in awake patients. The patient safety may be compromised by health-related, equipment-related, and procedure-related risks. Direct patient observation may be compromised by acoustic noise, darkened environment, obstructed line of sight, and distractions along with difficult access to the patient for airway management. Most often, the patient's head will be 180° away from the anesthesiologist during the procedure. Several monitors exist that are designed for conditional use in a MR environment. The general design criterion in these monitors is to eliminate conductors that carry electrical signals for monitoring physiologic parameters of the patient. General anesthesia requires an extended anesthetic circuit for ventilation maintenance and drug administration because the patient is located farther from the anesthesia machine than in traditional operating room settings. Dead space creates a time delay before the volatile anesthetic and drugs are administered and when expected effects can be observed. Therefore, the attending anaesthesiologists must understand the above aspects for safe conduct of neurosurgical procedures by minimizing MRI associated accidents while assuring optimal patient vigilance.
基金This study was supported by grants of the Ministry of Health of China （2010-2012）, National Natural Science Foundation of China （No. 81071117, No. 81171295）, and Shanghai Municipal Health Bureau （No. XBR2011022）. Conflicts of interest： none.
文摘Background Intraoperative magnetic resonance imaging （iMRI） dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI （〈1.0T）. This paper reports the clinical experience with a 3T iMRI-integrated neurosurgical suite in Huashan Hospital, Shanghai, China. Methods From September 2010 through March 2012, 373 consecutive patients underwent neurological surgery under guidance with 3T iMRI. A retrospective analysis was conducted regarding clinical efficiency. Results All surgery in the 373 patients was safe. The ratio of gross total resection for cerebral gliomas （n=161） was increased from 55.90% to 87.58%. The ratio of benefit in extent of resection was 39.13%. One hundred and fifty eight of the 161 glioma patients accomplished follow-up at 3 months postoperatively. Twenty of 161 patients （12.42%） suffered from early motor deficit after surgery. Late motor deficit was however observed in five of 158 patients （3.16%）. Twenty-one of 161 patients （13.04%） had early speech deficit and late speech deficit was only observed in six of 158 patients （3.80%）. The ratio of gross total resection for pituitary adenomas （n=49） was increased from 77.55% to 85.71%. The ratio of benefit in extent of resection was 10.2%. There were no iMRI-related adverse events even for patients who underwent awake craniotomy. Conclusion The 3T iMRI integrated neurosurgical suite provides high-quality intraoperative structural and functional imaging for real-time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.
文摘The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been in-troduced, including an operating microscope in the late 1950 s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging(DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging(DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resec-tion cavity and thus overcome this remaining uncer-tainty of intraoperative MRI in high grade brain tumor resection.
文摘The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the detection of metastases.In particular,contrast enhanced ultrasonography(CEUS)allows the display of the parenchymal microvasculature,enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases,which is similar to contrast-enhanced computed tomography(CT)and contrast-enhanced magnetic resonance imaging.Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US.Furthermore,studies have shown that CEUS yields sensitivities comparable to CT.In this review,we describe the state of the art of CEUS for detecting colorectal liver metastases,the imaging features,the literature reports of metastases in CEUS as well as its technique,its clinical role and its potential applications.Additionally,the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.
文摘Objective: To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Methods: Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative“visu-alization”of surrounding eloquent structures,“brain shift”corrections, and navigational plan updates. Results: All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative “brain shift” severely deterred locating of the lesions;however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Conclusions: Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.
文摘AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospective analyzed.The sensitivity,specificity,false negative and false positive rates of contrast enhanced magnetic resonance imaging(CE-MRI),IOUS and CEIOUS were calculated and compared.Surgical strategy changes due to CE-IOUS were analyzed.RESULTS:Lesions detected by CE-MRI,IOUS and CEIOUS were 60,97 and 85 respectively.The sensitivity,specificity,false negative rate,false positive rate of CEMRI were 98.2%,98.6%,98.6%,60.0%,respectively;for IOUS were 50.0%,90.9%,1.8%,1.4%,respectively;and for CE-IOUS were 1.4%,40.0%,50.0%,9.1%,respectively.The operation strategy of 9(9/50,18.0%) cases was changed according to the results of CE-IOUS.CONCLUSION:Compared with CE-MRI,CE-IOUS performs better in detection and differentiation of small metastasis and regenerative nodules.It plays an important role in the decision-making of HCC operation.
文摘Arteriovenous malformations(AVMs)are vascularabnormalities that consist of multiple fistulousconnections between arteries and veins without the normalintervening capillary bed.Microsurgical resection is
文摘目的探讨氢质子磁共振波谱(proton magnetic resonance spectroscopy,1H-MRS)联合术中磁共振(in-traoperative magnetic resonance imaging,iMRI)导航在颅内病变穿刺活检的应用。方法使用兼具有1H-MRS功能的1.5 T术中磁共振系统,并配有导航计算机成像系统。26例颅内病变患者,先使用1H-MRS分析病灶组织生化及代谢情况,然后在iMRI导航引导下根据病变不同部位代谢情况对病变相应区域进行穿刺活检。结果 26例患者穿刺成功,25例病变组织获得组织病理学诊断。所有病例术中及术后均未出现明显并发症如严重出血、新发神经功能障碍等。结论 1H-MRS分析能提供病变的代谢信息,并帮助确定最佳活检取材点,iMRI导航能精确定位,并在术中明确取材位置和排除出血等并发症,1H-MRS联合iMRI导航在颅内病变活检是一种精准、有效、安全的技术。
文摘目的评价3.0 T术中磁共振成像(intraoperative magnetic resonance imaging,iMRI)联合弥散张量成像(diffusion tensor imaging,DTI)锥体束示踪导航及术中神经电生理监测(intraoperative neurophysiologicalmonitoring,IONM)技术在各种累及岛叶的胶质瘤切除手术中的应用价值。方法 2010年9月至2011年6月以3.0 T iMRI数字一体化神经外科手术中心为平台,在iMRI功能导航结合IONM下对18例累及岛叶的胶质瘤实施切除手术。其中对10例主侧半球肿瘤采用唤醒麻醉下术中直接皮质电刺激进行语言区定位。对所有18例岛叶胶质瘤,术中均采用DTI导航结合术中连续经皮质刺激运动诱发电位和皮质下电刺激进行锥体束定位。结果通过iMRI实时扫描,18例患者中有13例发现肿瘤残留,其中6例在iMRI实时影像导航下获得了进一步切除,使肿瘤的影像学全切除率从5/18提高至9/18。经Fisher检验,iMRI前、后的肿瘤切除率(包括全切除及次全切除)具有统计学意义(P=0.046)。9例因DTI导航或IONM提示切缘临近功能皮质或深部锥体束,而未强求全切除。10例主侧半球肿瘤患者中,术后近期(1周内)出现一过性语言功能障碍5例,随访至术后1个月,语言功能均恢复到术前水平或以上;18例患者中3例术后近期出现肢体运动功能障碍,随访至术后1个月,其中2例完全恢复。总体术后1个月的神经功能障碍仅1例。无iMRI及IONM相关的并发症发生。结论应用3.0 T iMRI术中实时影像导航联合DTI锥体束示踪成像技术及IONM技术有助于最大程度地安全切除岛叶胶质瘤。
