Surgical Planning LaboratoryBrigham and Women’s HospitalBoston, Massachusetts USA
a teaching affiliate ofHarvard Medical School
Visit of Barbara Alving, M.D. 8-15-05
Ron Kikinis, M.D.
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Overview
• Prostate: – Clare Tempany, Noby Hata, Steve Haker
• Neurosurgery: – Alex Golby, Steve Pieper, Sandy Wells, CF Westin
• Programmatic targets: – NAC Ron Kikinis, BIRN: Steve Pieper, IGT: Clare
Tempany, Randy Ellis
• Targets for your presentations: – What is your science (explanation targeted at a
clinician)– How do you fit into the different programs
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Schedule
• Prostate
• Neurosurgery
• NCRR portfolio
• Discussion
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Prostate
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Neurosurgery
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Functional imaging and electrocorticography-guided surgery in eloquent cortex
• Surgical resection is most effective initial therapy for a variety of brain tumors
• Maximal surgical excision relieves mass effect, decreases tumor burden, decreases incidence of seizures and may prolong time to recurrence and survival
• Defining limits of the resection difficult due to gross similarity of tumor and brain tissue
• Adjacency of essential cortex (e.g. motor, language) makes distinction critical
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Intra-operative MRI at BWH
• Craniotomy=699
• Brain biopsy=180
• LASER ablation=9
• Transsphenoidal pituitary adenoma resection
• Total=918
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MRT allows surgeon to visualize resection progress and brain shift
F. Talos
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• Motor, visual cortex well demonstrated
• Language lateralization
• Increasingly, language localization and memory
Functional MRI can provide a pre-operative map of critical brain areas
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Imaging white matter tracts
• MRI measures diffusion of water.• Water proton diffusion facilitated
parallel to fibers and restricted perpendicular
• anisotropic diffusion tensor imaging • Trajectory and location of white matter
tracts• Three types of lesion/fiber tract
interactions may occur: – fiber tract displacement– infiltration– destruction
Higher diffusionalong fiber
Lower diffusion across fiber
axons
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Stimulation mapping to locate essential cortical areas
Fiber tracts
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Image coregistration and fusion
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Intraoperative image fusion and display: fMRI and Cortical Stimulation
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Conclusions and Future Directions
• Multi-modality image fusion• Intra-operative functional testing annotation• Develop paradigms which work well for
patients with neurologic deficits• Integrate fMRI with DTI and other imaging
modalities• Improve ability to predict post-operative
outcomes and avoid neurologic injury• Correlate fMRI signal with neuronal activity
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NCRR portfolio
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NACFocus: specific applications,
custom software toolse.g. Tensor analysis for
pioneering diffusion technology from BWH
BIRNFocus: infrastructure, data,
data distributione.g. Provides shared image databases and
high speed network/computing for NA-MIC & NAC
NA-MICFocus: algorithms, engineering,
general software toolse.g. Analysis of tensor and non-tensor diffusion data
at three algorithm groups (UNC, Utah, MGH) , hosted on BIRN servers from four clinical sites
(Dartmouth, Harvard, UCI, U of Toronto)
National Level Science
National Level Outreach
Advances in medical image computingData repositories and access
Data
Requirements,testing, tools
Research Interactions between NA-MIC, NAC, BIRN
Local Level Science
National Level Outreach