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Intraoperative High-Field-Strength MR Imaging: Implementation and Experience in 200 Patients¹

¹ From the Department of Neurosurgery, University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany. Received August 23, 2003; revision requested NoGvember 6; final revision received January 26, 2004; accepted February 16. Supported by the Deutsche Forschungsgemeinschaft and the Wilhelm-Sander-Stiftung. Address correspondence to C.N. (e-mail: nimsky@nch.imed.uni-erlangen.de).

View larger version (86K): [in a new window]   Figure 1a. (a) Floor plan of operating theater shows two possible operating positions: at 0.5-mT line, with full use of the microscope-based navigation system (A); and in high magnetic field, with use of fully MR-compatible instruments only (B). (b) Panoramic photograph shows operating theater during glioma surgery with the microscope-based navigation system.

View larger version (72K): [in a new window]   Figure 1b. (a) Floor plan of operating theater shows two possible operating positions: at 0.5-mT line, with full use of the microscope-based navigation system (A); and in high magnetic field, with use of fully MR-compatible instruments only (B). (b) Panoramic photograph shows operating theater during glioma surgery with the microscope-based navigation system.

View larger version (189K): [in a new window]   Figure 2. MR images in a 29-year-old female patient in less than minute with T2-weighted half-Fourier rapid acquisition with relaxation enhancement (1000/89). Preoperative images show sagittal (A) and coronal (B) views of intra- and suprasellar pituitary adenoma (arrows). Intraoperative images show sagittal (C) and coronal (D) views of extent of resection.

View larger version (167K): [in a new window]   Figure 3. Sagittal MR images in a 56-year-old woman with pituitary adenoma. A-C, T1-weighted (450/12) images. D, E, T2-weighted (4000/97) images. A, Preoperative image shows large intra- and suprasellar pituitary adenoma (arrow). B, Intraoperative image acquired after initial resection shows small tumor remnant in posterior portion of the sella (arrow), which was removed with further resection. C, Postoperative image shows no evidence of tumor after further resection. Intraoperative (D) and postoperative (E) high-spatial-resolution T2-weighted images provide, respectively, clearer delineation of tumor remnant (arrow) and of its absence after resection.

View larger version (161K): [in a new window]   Figure 4. Transverse MR images in a 45-year-old male patient with left-sided glioblastoma. Preoperative views obtained with T1-weighted (A; 525/17), T2-weighted (B; 6490/98), and fluid-attenuated inversion-recovery (C; 10 000/103) sequences show tumor with contrast material-enhanced areas (arrows). D-F, Corresponding intraoperative images obtained with the same series of pulse sequences as in A-C show that contrast-enhanced areas of tumor have been completely removed.

View larger version (105K): [in a new window]   Figure 5. Transverse T2-weighted (6490/98) MR images in a 20-year-old woman with right-sided precentral astrocytoma of WHO grade II. A, Preoperative tumor. B, Intraoperative image shows complete tumor removal.

View larger version (154K): [in a new window]   Figure 6. T2-weighted (6490/98) MR images in a 30-year-old woman with pharmacoresistant epilepsy caused by temporal lobe abnormality. A-C, Transverse views. D-F, coronal views. A, D, Preoperative images. B, E, Intraoperative images of corresponding sections after craniotomy and placement of subdural strip electrodes (arrow in B, small arrows in E) and hippocampal electrode (large arrow in E). C, F, Intraoperative images of same sections after tailored right temporal lobectomy.

View larger version (91K): [in a new window]   Figure 7. Coronal T2-weighted (6490/98) MR images in a 37-year-old man with ventricular neurocytoma. A, Preoperative image shows tumor location and indicates transcallosal approach. B, Intraoperative image shows tumor remnants (arrows). C, Intraoperative image obtained after further resection confirms complete removal of tumor.