High-resolution three-dimensional T2-weighted sequence for neuronavigation: a new setup and clinical trial

Area of Science:

• Neurosurgery
• Medical Imaging
• Radiology

Background:

• Conventional neuronavigation relies on CT or T1-weighted MRI, which may not optimally visualize certain lesions.
• Low-resolution fusion of T2-weighted images with other modalities compromises 3D reconstruction accuracy for neuronavigation.
• Improved visualization of specific brain lesion types is crucial for accurate surgical guidance.

Purpose of the Study:

• To develop and evaluate a novel 3D T2-weighted isovoxel sequence (3D TSE) for whole-brain neuronavigation.
• To assess the clinical applicability and accuracy of the 3D TSE sequence in image-guided surgery.
• To determine if 3D TSE imaging can overcome limitations of conventional methods for specific lesion visualization.

Main Methods:

• A phantom study and a clinical trial involving 25 patients were conducted using a 1.5-tesla MR imager.
• The newly developed 3D TSE sequence was integrated with a pointer-based neuronavigation system (Medtronic Stealth Station Treon).
• Registration accuracy and intraoperative guidance were evaluated, alongside the visualization of skin fiducial markers and specific lesion types.

Main Results:

• The 3D TSE sequence demonstrated high registration accuracy in both experimental and clinical settings.
• The sequence successfully provided convincing delineation of hyperintense lesions on T2-weighted images, such as low-grade gliomas and cavernomas.
• The 3D TSE data set was easily applied to the neuronavigational setup, showing reliable performance.

Conclusions:

• 3D TSE imaging expands the available datasets for neuronavigation and intraoperative guidance.
• The sequence offers reliable registration accuracy and high-resolution 3D reconstruction in any orientation.
• This technology maintains the advantages of image-guided surgery, particularly for lesions better visualized on T2-weighted MRI.