Application of multimodal image fusion technology in brain tumor surgical procedure
Jiefei Li1, Yuqi Zhang1, Le He2, Huancong Zuo1
1. Department of Neurosurgery, Medical Center, Tsinghua University, Yuquan Hospital, Beijing 100084, China;
2. Center for Biomedical Imaging Research, Tsinghua University, Beijing 100084, China
Application of multimodal image fusion technology in brain tumor surgical procedure
Jiefei Li1, Yuqi Zhang1, Le He2, Huancong Zuo1
1. Department of Neurosurgery, Medical Center, Tsinghua University, Yuquan Hospital, Beijing 100084, China;
2. Center for Biomedical Imaging Research, Tsinghua University, Beijing 100084, China
摘要 Objective: To construct brain tumors and their surrounding anatomical structures through the method of registration, fusion and, three-dimensional (3D) reconstruction based on multimodal image data and to provide the visual information of tumor, skull, brain, and vessels for preoperative evaluation, surgical planning, and function protection. Methods: The image data of computed tomography (CT) and magnetic resonance imaging (MRI) were collected from fifteen patients with confirmed brain tumors. We reconstructed brain tumors and their surrounding anatomical structures using NeuroTech software. Results: The whole 3D structures including tumor, brain surface, skull, and vessels were successfully reconstructed based on the CT and MRI images. Reconstruction image clearly shows the tumor size, location, shape, and the anatomical relationship of tumor and surrounding structures. We can hide any reconstructed images such as skull, brain tissue, blood vessles, or tumors. We also can adjust the color of reconstructed images and rotate images to observe the structures from any direction. Reconstruction of brain and skull can be semi transparent to display the deep structure; reconstruction of the structures can be axial, coronal, and sagittal cutting to show relationship among tumor and surrounding structures. The reconstructed 3D structures clearly depicted the tumor features, such as size, location, and shape, and provided visual information of the spatial relationship among its surrounding structures. Conclusions: The method of registration, fusion, and 3D reconstruction based on multimodal images to provide the visual information is feasible and practical. The reconstructed 3D structures are useful for preoperative assessment, incision design, the choice of surgical approach, tumor resection, and functional protection.
Abstract: Objective: To construct brain tumors and their surrounding anatomical structures through the method of registration, fusion and, three-dimensional (3D) reconstruction based on multimodal image data and to provide the visual information of tumor, skull, brain, and vessels for preoperative evaluation, surgical planning, and function protection. Methods: The image data of computed tomography (CT) and magnetic resonance imaging (MRI) were collected from fifteen patients with confirmed brain tumors. We reconstructed brain tumors and their surrounding anatomical structures using NeuroTech software. Results: The whole 3D structures including tumor, brain surface, skull, and vessels were successfully reconstructed based on the CT and MRI images. Reconstruction image clearly shows the tumor size, location, shape, and the anatomical relationship of tumor and surrounding structures. We can hide any reconstructed images such as skull, brain tissue, blood vessles, or tumors. We also can adjust the color of reconstructed images and rotate images to observe the structures from any direction. Reconstruction of brain and skull can be semi transparent to display the deep structure; reconstruction of the structures can be axial, coronal, and sagittal cutting to show relationship among tumor and surrounding structures. The reconstructed 3D structures clearly depicted the tumor features, such as size, location, and shape, and provided visual information of the spatial relationship among its surrounding structures. Conclusions: The method of registration, fusion, and 3D reconstruction based on multimodal images to provide the visual information is feasible and practical. The reconstructed 3D structures are useful for preoperative assessment, incision design, the choice of surgical approach, tumor resection, and functional protection.
20170308095603 Table 3 Specific sources of fusion structures
20170308095715 Figure 1 Magnetic resonance imaging, reconstruction images, surgical incision, and actual operative view in a 51-year-old male patient with a meningioma in right parietal lobe. (a, b) T1 enhancement scans: The tumor presented as homogenous enhancement. (c) 3D reconstruction (skull semitransparent): The tumor (vertical single arrow) located above lambdoidal suture (horizontal double arrow) and the superior cerebral veins (horizontal single arrow) are faintly visible. (d) 3D reconstruction (do not show the skull): On the surface of brain adjacent to the tumor are superior cerebral veins and superior sagittal sinus. (e) Sagittal cutting: The tumor is above the vein of galen and straight sinus. (f, g) The comparison of intraoperative situation and 3D reconstruction: The intraoperative situation is consistent with 3D reconstruction images. (h) Surgical incision.
20170308100004 Figure 2 Magnetic resonance imaging, reconstruction images, and 3D view of MRI in an 66-year-old female patient with a meningioma in right frontal lobe. (a) T1 enhancement scans: The tumor presented as homogenous enhancement and the precentral gyrus is located anterior to the tumor. (b) 3D reconstruction (skull semitransparent): The tumor (horizontal single arrow) located behind the coronary suture (horizontal double arrow) and the markers (vertical single arrow) are around the tumor. The superior sagittal sinus and superior cerebral veins are faintly visible. (c) 3D reconstruction (do not show the skull): The tumor (horizontal single arrow) is adjacent to the superior sagittal sinus (vertical single arrow). (d) 3D reconstruction (lateral view, brain tissue semitransparent): The tumor is adjacent to the superior sagittal sinus and locates on the surface of the brain. The positional relationship between the tumor and markers can be seen clearly. (e) 3D view: The images of 3D reconstruction are consistent with that of T1 enhancement MRI.
20170308100354 Figure 3 Magnetic resonance imaging, reconstruction images, and actual operative view in a 62-year-old female patient with a malignant meningioma in right frontal lobe. (a, b) T1 enhancement scans: The tumor presented as heterogeneous enhancement. (c) 3D reconstruction: The tumor located behind the coronary suture (horizontal double arrow) and adjacent to sagittal suture (vertical single arrow). (d) 3D reconstruction (skull semitransparent): This picture not only shows the relationship between tumor and sutures (coronary suture, horizontal double arrow; sagittal suture, vertical single arrow) but also shows the relationship between tumor and the superior cerebral veins (horizontal double arrow). (e) 3D reconstruction (do not show the skull): The tumor locates between two superior cerebral veins (horizontal single arrow). (f) 3D reconstruction: This picture only shows the tumor and veins. (g) Intraoperative situation: The intraoperative situation is consistent with 3D reconstruction images.
20170308100624 Figure 4 Magnetic resonance imaging and reconstruction images in a 36-year-old female patient with a meningioma in left frontal lober. (a, b) T1 enhancement scans: The tumor presented as heterogeneous enhancement and locates anerior to left postcentral gyrus (horizontal single arrow). (c) 3D reconstruction (skull semitransparent): The tumor (horizontal single arrow) located behind the coronary suture (horizontal double arrow) and adjacent to sagittal suture (vertical single arrow). (d) 3D reconstruction (do not show the skull): The tumor locates anterior to the left postcentral gyrus (vertical single arrow) and the right side of the tumor is adjacent to the superior sagittal sinus (vertical single arrow).
20170308100717 Figure 5 Magnetic resonance imaging, reconstruction images, and actual operative view in a 24-year-old female patient with a glioblastoma in left frontal lobe. (a, b) T1 enhancement scans: The tumor presented as heterogeneous enhancement. (c) 3D reconstruction: 3D reconstruction (skull semitransparent): This picture not only shows the relatioshop between tumor and sutures (vertical double arrow) but also shows the relatioshop between tumor (vertical single arrow) and the superior cerebral veins (horizontal single arrow). (d) 3D reconstruction (do not show the skull): The superior cerebral veins are shown clearly and the tumor (vertical single arrow) is under one large superior cerebral vein (horizontal single arrow). (e) 3D reconstruction (superolateral view, skull, and brian tissue semitransparent): In this picture, we can see tumor, markers, superior cerebral veins, and brain tissue simultaneously. (f) Intraoperative situation: The intraoperative situation is consistent with 3D reconstruction images.
20170308100832 Figure 6 Magnetic resonance imaging, reconstruction images, surgical incision, 3D view, and actual operative view in a 55-year-old male patient with a meningioma in right frontal lobe. (a, b) T1 enhancement scans: The tumor presented as homogenous enhancement. (c) 3D reconstruction (skull semitransparent): The tumor (vertical single arrow) located behind the coronary suture (horizontal double arrow) and adjacent to sagittal suture. The right central sulcus vein (horizontal single arrow) is under the tumor. (d) 3D reconstruction (do not show the skull): The tumor is adjacent to the superior sagittal sinus (vertical single arrow) and superior sagittal sinus (vertical single arrow). (e) 3D reconstruction (lateral view): The tumor is adjacent to the superior sagittal sinus and locates on the surface of the brain above the right central sulcus vein (horizontal single arrow). The markers are around the tumor. (f) Intraoperative situation: The intraoperative situation is consistent with 3D reconstruction images. (g) Surgical incision. (h) 3D view: The images of 3D reconstruction are consistent with that of T1 enhancement MRI.
20170308100930 Figure 7 Magnetic resonance imaging, reconstruction images, surgical incision, and 3D view in a 51-year-old male patient with a glioblastoma in right frontal lobe. (a, b) T1 enhancement scans: The tumor presented as heterogeneous enhancement. (c) 3D reconstruction (skull semitransparent): The scalp blood vessels have been shown clearly. The tumor and superior cerebral veins are faintly visible. (d) 3D reconstruction (lateral view, do not show the skull): The tumor located under the markers. The veins, arteris, brian surface, and markers have shown clearly and the tumor is faintly visible. (e) Surgical incision. (f) 3D views: The images of 3D reconstruction are consistent with that of T1 enhancement MRI.
20170308101048 Figure 8 Magnetic resonance imaging, reconstruction images, surgical incision, 3D view, and actual operative view in a 51-year-old male patient with a vascular malformation in right frontal lobe. (a, b) T1 enhancement scan: The cyst presented as no enhancement; (b) T2 scan: The cyst presented as high signal. (c) 3D reconstruction (skull semitransparent): The cyst (vertical single arrow) located behind the coronary suture (horizontal double arrow) and the markers are around the cyst. The superior sagittal sinus and superior cerebral veins (horizontal single arrow) are faintly visible. (d) 3D reconstruction (do not show the skull): The cyst (vertical single arrow) is faintly visible and locates anterior to one superior cerebral vein. The veins on the surface of the brain can be seen clearly. (e) 3D reconstruction (lateral view): The cyst (horizontal single arrow) is anterior to one superior cerebral vein and locates under the motor cortex. (f) Sagittal cutting: The corpus callosum (horizontal single arrow) is compressed by the cyst. (g) Coronay cutting: The lateral ventricle and corpus callosum are compressed by the cyst. (h) 3D view: The images of 3D reconstruction are consistent with that of flair MRI. (i) The comparison of intraoperative situation and 3D reconstruction: The intraoperative situation is consistent with 3D reconstruction images.
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