Target definition and trajectory optimization for interactive MR-guided biopsies of brain tumors in an open...

We present an imaging strategy for planning and guiding brain biopsies in an open configuration MR system. Preprocedure imaging was performed in a 1.5-T MR system and was designed to provide, in a clinically efficient manner, high resolution anatomical and functional/physiologic information for precise definition and tissue characterization of the target, aiming at optimization of the biopsy trajectory for planning a safe and accurate procedure. The interventions were performed in a .5-T open bore magnet, and imaging was optimized to provide the imaging quality and temporal resolution necessary for performing the procedure interactively in near real time. Brain biopsies of 21 patients were performed in a 10-month period. Segmentation and surface rendering analysis of the lesions and vascular structures and dynamic MR perfusion and cortical activation studies provided an efficient and comprehensive way to appreciate the relationship of the target to surrounding vital structures, improved tissue characterization and definition of the tumor margins, and demonstrated the location of essential cortex, allowing appropriate placement of the burr hole and choice of optimal trajectory. Interactive protocols provided good visualization of the target and the interventional devices and offered the operator real-time feedback and control of the procedure. No complications were encountered. Advanced methods of image acquisition and processing for accurate planning of interventional brain procedures and interactive imaging with MR guidance render feasible the performance of safe and accurate neurointerventional procedures.