Affiliation:
1. Department of Neurosurgery University of Ulm, Günzburg, Germany
2. Department of Radiology University of Ulm, Günzburg, Germany
3. Department of Nuclear Medicine University of Ulm, Günzburg, Germany
Abstract
Abstract
OBJECTIVE
This is the first report of the direct integration of functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) data into cranial neuronavigation.
METHODS
In a patient with a left precentral oligodendroglioma (World Health Organization Grade III), the Zeiss MKM system (Carl Zeiss Co., Oberkochen, Germany) was used for navigation based on thin-slice, T1-weighted, contrast-enhanced magnetic resonance imaging (MRI) scans. fMRI and methionine PET data were integrated by landmark matching, with reference to skin fiducials.
RESULTS
The inaccuracy of the image fusion between fMRI and T1-weighted MRI data was 1.7 mm, that between PET and T1-weighted MRI data was 4.3 mm, and that for the subsequent registration of the navigation was 1.2 mm. The correct fMRI localization of the precentral gyrus was intraoperatively verified by cortical somatosensory evoked potential (phase-reversal) monitoring. Although the tumor was not clearly defined in the MRI scans, [11C]methionine PET demonstrated a clear tumor border, enabling us to achieve gross total tumor removal without postoperative functional deficits.
CONCLUSION
Functional neuronavigation permits observation and preservation of relevant brain areas. Other functional areas (such as short-term memory areas) that can be detected only by fMRI might also warrant future monitoring. The simultaneous integration of fMRI and PET data adds a new dimension to cranial neuronavigation, enabling the observation of tumors in relation to functional cortical areas (in our case, the motor strip).
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Neurology (clinical),Surgery
Reference14 articles.
1. A method for coregistration of PET and MR brain images;Andersson;J Nucl Med,1995
2. 18-Fluorodeoxyglucose uptake and survival of patients with suspected recurrent malignant glioma;Barker;Cancer,1997
3. Neurofunctional MRI imaging of higher cognitive performance of the human brain [in German];Bellemann;Radiologe,1995
4. Localization of the motor hand area using transcranial magnetic stimulation and functional magnetic resonance imaging;Boroojerdi;Clin Neurophysiol,1999
5. Methyl 11C-thymidine positron emission tomography in tumoral and non-tumoral cerebral lesions;De Reuck;Acta Neurol Belg,1999
Cited by
40 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献