A FUSED PET/MRI IN A PLANNING AND PERFORMING STEREOTACTIC OPERATIONS IN BRAIN TUMORS

Objective – study of the diagnostic capabilities of MRI and PET/CT scanners and the available user programs for processing DICOM-images in the implementation of the preoperative planning of stereotactic interventions in patients with deep cerebral gliomas in terms of fusion the scans of a brain.

Material and methods. 35 stereotactic surgeries (biopsies and treatment cryoablations) were preplanned and then conducted in patients with brain deep-seated tumors. Patients underwent MRI-scanning in stereotactic conditions and PET/CT scanning with the tumor-specific radiotracer 11C-methionine for stereotactic targeting in preoperative period. Stereotactic planning was conducted on fused MRI/PET images. A co-registration was carried out using a diagnostic workstation Philips and neuronavigation station Medtronic StealthStation S7.

Results. A fusion of MRI and PET images using application software is a convenient tool for precise planning of target points and trajectories for insertion stereotactic cannula into a brain. On a fused image the PET-component enables to plan target areas for biopsy and selective ablation of the tumor, due to the ability of a radiotracer to accumulate selectively in the most malignant sites of a tumor. While MRI component, providing a clear anatomical visualization, allows the planning safe trajectories of stereotactic access out of eloquent areas, pathways of brain and intracerebral vessels, which reduces the risk of intraoperative complications. In addition, MRI provides imaging of fiducial markers for stereotactic calculations.

Conclusion. High efficiency of preoperative planning on fused MRI/PET scans was demonstrated. The proposed planning method allows to increase the effectiveness of biopsies and to prevent the prolonged growth of brain glial tumors, even when their selective stereotactic ablation, as well as to ensure a low level of postoperative complications.

1. Мартынов Б.В., Холявин А.И., Парфенов В.Е., Низковолос В.Б., Труфанов В.Е., Фокин В.А. и др. Метод стереотаксической криодеструкции в лечении больных с глиомами головного мозга. Вопросы нейрохирургии им. Н.Н. Бурденко. 2011; 75 (4): 17–24. [Martynov B.V., Kholyavin A.I., Parfenov V.E., Nizkovolos V.B., Trufanov V.E., Fokin V.A. et al. The method of a stereotactic cryodestruction in a treatment of patients with cerebral gliomas. Voprosy Neyrokhirurgii imeni N.N. Burdenko (Problems of Neurosurgery Named after N.N. Burdenko, Russian journal). 2011; 75 (4): 17–24 (in Russ.).]

2. Lunsford L.D., Somaza S., Kondziolka D., Flickinger J.C. Brain astrocytomas: biopsy, then irradiation. Clin. Neurosurg. 1995; 42: 464–79.

3. Kholyavin A.I., Nizkovolos V.B., Anichkov A.D. Tomography of brain and stereotactic guidance. Biomed. Engineer. 2014; 48 (1): 24–6.

4. Низковолос В.Б., Аничков А.Д. Устройство для криохирургического воздействия. Патент № 2115377 Российской Федерации. МПК7 А61В 17/36. Изобретения. Полезные модели. 1998; 20: 3 опубл. 20.07.98. [Nizkovolos V.B., Anichkov A.D. A device for a cryosurgery action. Patent № 2115377 Russian Federation, МPК7 А61В 17/36. Izobreteniya. Poleznye Modeli (Inventions. Useful models. Russian journal). 1998; 20: 3 published 20.07.98 (in Russ.).]

5. Полонский Ю.З., Холявин А.И., Мартынов Б.В., Парфенов В.Е., Труфанов В.Е. Безрамная расчетная магнитно-резонансная томография со стереотаксическими манипуляторами класса «Ореол». Вестник Российской военно- медицинской академии. 2009; 4 (28): 71–8. [Polonskiy Yu.Z., Kholyavin A.I., Martynov B.V., Parfenov V.E., Trufanov V.E. Use of stereotaxic manipulators of the Oreol class for frameless stereotaxic magnetic resonance imaging. Vestnik Rossiyskoy Voenno-Meditsinskoy Akademii (Herald of Russian Military Medical Academy, Russian journal). 2009; 4 (28): 71–8 (in Russ.).]

6. Холявин А.И., Низковолос В.Б., Аничков А.Д. Прецизионная стереотаксическая безрамная нейронавигация. Медицинская техника. 2016; 4: 26–8. [Kholyavin A.I., Nizkovolos V.B., Anichkov A.D. Precision stereotaxic frameless neuronavigation. Meditsinskaya Tekhnika (Medical Equipment, Russian journal). 2016; 4: 26–8 (in Russ.).]

7. Гомзина Н.А., Кузнецова О.Ф. Получение L-[метил-(11C)]метионина высокой энантиомерной чистоты путем on-line-11C-метилирования L-гомоцистеинтиолактонгидрохлорида. Биоорганическая химия. 2011; 37: 216–22. [Gomzina N.A., Kuznetsova O.F. Preparation of [11C-methyl]-Lmethionine in high enantiomeric purity by “on-line” 11C-methylation. Bioorganicheskaya Khimiya (Bioorganic Chemistry, Russian journal). 2011; 37: 216–22 (in Russ.).]

8. Kunz M., Thon N., Eigenbrod S., Hartmann C., Egensperger R., Herms J. et al. Hot spots in dynamic (18) FET-PET delineate malignant tumor parts within suspected WHO grade II gliomas. Neuro-oncology. 2011; 13 (3): 307–16.

9. Pirotte B., Goldman S., Massager N., David P., Vandesteene A., Salmon I. et al. Comparison of 18F-FDG and 11C-methionine for PET-Guided stereotactic brain biopsy of gliomas. J. Nucl. Med. 2004; 45 (8): 1293–8.

10. Van Laere K., Ceyssens S., Van Calenbergh F., de Groot T., Menten J., Flamen P. et al. Direct comparison of 18F-FDG and 11C-metionine PET in suspected of glioma: sensitivity, inter-observer variability und prognosis value. Eur. J. Nucl. Med. Mol. Imag. 2005; 32 (1): 39–51.

11. Kläsner B.D., Krause B.J., Beer A.J., Drzezga A. PET imaging of gliomas using novel tracers: a sleeping beauty waiting to bekissed. Expert Rev. Anticancer. Ther. 2010; 10 (5): 609–13.

12. Hariz M.I. CT scanning in stereotactic neurosurgery. In: Gildenberg P.L., Tasker R.R. (eds.) Textbook of stereotactic and functional neurosurgery. New-York: McGraw-Hill; 1998: 265–70.

13. Simon S.L., Douglas P., Baltuch G.H., Jaggi J.L. Error analysis of MRI and Leksell stereotactic frame target localization in deep brain stimulation surgery. Stereotac. Functional Neurosurg. 2005; 83 (1): 1–5.

14. Yu C., Apuzzo M.L., Zee C.S., Petrovich Z. A phantom study of the geometric accuracy of computed tomographic and magnetic resonance imaging stereotactic localization with the Leksell stereotactic system. Neurosurgery. 2001; 48 (5): 1092–8.

15. Mori Y., Hayashi N., Iwase M., Yamada M., Takikawa Y., Uchiyama Y. et al. Stereotactic imaging for radiosurgery: localization accuracy of magnetic resonance imaging and positron emission tomography compared with computed tomography. Stereotact. Functional Neurosurg. 2006; 84 (4): 142–6.

16. Kuhn S.A., Romeike B., Walter J., Kalff R., Reichart R. Multiplanar MRI-CT fusion neuronavigationguided serial stereotactic biopsy of human brain tumors: proof of a strong correlation between tumor imaging and histopathology by a new technical approach. J. Cancer Res. Clin. Oncol. 2009; 135 (9): 1293–302.

17. Низковолос В.Б., Холявин А.И., Гурчин А.Ф. Практические аспекты использования совмещенной МСКТ-ПЭТ в стереотаксической нейроонкологии. Российский нейрохирургический журнал им. про- фессора А.Л. Поленова. 2012; 4 (2): 16–9. [Nizkovolos V.B., Kholyavin A.I., Gurchin A.F. The practical aspects of using the combined CTPET in stereotactic neuro-oncology. Rossiyskiy Neyrokhirurgicheskiy Zhurnal imeni professora A.L. Polenova (Russian Neurosurgery Journal named after A.L. Polenov). 2012; 4 (2): 16–9 (in Russ.).]

18. Guihong Q., Dali Z., Pingfan Y. Medical image fusion by wavelet transform modulus maxima. Optics Express. 2001; 9 (4): 184–90.

19. Ganasala P., Kumar V. CT and MR image fusion scheme in nonsubsampled contourlet transform domain. J. Digital Imag. 2014; 27 (3): 407–18