f mri radiologendagen 2012 aart issa
TRANSCRIPT
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Preoperatieve fMRI/DTI combinatie met 1.5 T
Aart I. Issa-Epe, AIOS Radiologie MCAB.M. Wiarda
W.F. Tan
P.R. Algra
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Doel
• Neurochirurgische patiënten:– Functional magnetic resonance imaging (fMRI)– Diffusion tensor imaging (DTI) fiber tracking
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fMRI en DTI
• Significant effect op chirurgische planning• Agressievere benadering1
• Bevestiging irresectabiliteit1
1 Petrella JR, Shah LM, Harris KM, Friedman AH, George TM, Sampson JH, Pekala JS, Voyvodic JT. Preoperative Functional MR Imaging Localization of Language and Motor Areas: Effect on Therapeutic Decision Making in
Patients with Potentially Resectable Brain Tumors. Radiology 2006;3:793-802.
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fMRI
• Verandering oxygenatie haemoglobine• Verandering magnetische eigenschappen• Verschillen oxyhaemoglobine en
deoxyhaemoglobine
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DTI
• Oriëntatie witte stof banen• Anisotropische eigenschappen• Watermoleculen in axonen diffunderen meer
in de lengterichting dan loodrecht– Myeline omgeven banen
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De praktijk
• 1.5 T MRI (Siemens Avanto)• fMRI en DTI radioloog en neurochirurg
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De praktijk
• Specifieke corticale gebieden– Motorisch– Spraakcentrum– Visueel
• 11 fasen– 6 rust– 5 stimulatie
• 30 tot 60 minuten
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Motorische cortex
• Finger tapping• Wijsvinger en duim tegen elkaar tikken
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Spraakcentrum
• Woorden maken• Met letter woorden maken
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Visuele cortex
• Plaatjes benoemen• Figuur op scherm in hoofd benoemen
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Casus 1, V 53 jr
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Casus 2, M 61 jr
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Casus 3, M 67 jr
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Casus 4, V 47 jr
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Conclusie
• Met 1.5 T adequate fMRI en DTI preoperatief• Combinatie van fMRI en DTI betere weergave
kritieke corticale gebieden en zenuwbanen• Goede samenwerking belangrijk voor kwaliteit
en beoordeling
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Referenties• 1. Petrella JR, Shah LM, Harris KM, Friedman AH, George TM, Sampson JH, Pekala
JS, Voyvodic JT. Preoperative Functional MR Imaging Localization of Language and Motor Areas: Effect on Therapeutic Decision Making in Patients with Potentially Resectable Brain Tumors. Radiology 2006;3:793-802.
• 2. Wilkinson ID, Romanowski CAJ, Jellinek DA, Morris J, Griffiths PD. Motor functional MRI for pre-operative and intraoperative neurosurgical guidance. The British Journal of Radiology 2003;76:98-103.
• 3. Ten Donkelaar HJ. Clinical Neuroanatomy. Brain Circuitry and Its Disorders. 2011:107-131.
• 4. Krasnow B, Tamm L, Greicius MD, Yang TT, Glover GH, Reiss AL, Menon V. Comparison of fMRI activation at 3 and 1.5 T during perceptual, cognitive and affective processing. NeuroImage 2003;18:813-826.
• 5. Voss HU, Zevin JD, McCandliss BD. Functional MR Imaging at 3.0 T versus 1.5 T: A Practical Review. Neuroimaging Clinics of North America 2006;16:285-297.
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Met dank aan
• B.M. Wiarda, radioloog MCA• W.F. Tan, neurochirurg MCA• P.R. Algra, radioloog MCA