Vinsamlegast notið þetta auðkenni þegar þið vitnið til verksins eða tengið í það: http://hdl.handle.net/1946/25607
Every year more than 100 brain surgeries are performed at the neurosurgical department at Landspitali University Hospital (LSH). In many cases the use of a technology called Diffusion Tensor Imaging (DTI) tractography would be beneficial in surgical planning to visualize the nerve fibers preoperatively and as well intraoperatively associated with surgical navigation systems.
The present work aims are: 1) to assess which conditions are needed at LSH in order to integrate DTI tractography in neurosurgical planning 2) develop a process that allow to combine DTI tractography and 3D printing technology that can improve surgical planning.
Magnetic Resonance images (MRI) were acquired from 4 subjects with low grade glioma on a 1.5 T Siemens Avanto system. The image protocol included: 1) T1-weighted gradient echo structural and 2) echo planar imaging (SE-EPI) based diffusion tensor imaging (DTI) sequence with 20 diffusion directions.
Five eloquent fiber tracts (Corpus callosum, Motor tracts, Sensory tracts, Optic tracts and arcuate fasciculus) were traced for all patients using two different DTI software platforms. A grading system was developed to rate anatomic accuracy and incorrectly displayed fibers tracts. Additionally a quantitative assessment in 3D was performed between the tracts volume in the two software systems.
The results show that the DTI planning performed with different software platforms can provide diverse results. Even within the same software some tracts may result of better quality compared to others. In this work corpus callosum received the highest score. The results from the volumetric comparison show that in some case there are missing parts of a tract that can be important for surgical planning such as arcuate fasciculus. Moreover, this work demonstrate that the 3D printing process may be integrated with DTI planning and add valuable information for neurosurgical planning especially when associated to navigation systems. Finally, the results of this study show the variability of DTI planning between different software platforms and its unreliability in some cases, mostly because of the false positive results.
Concluding, this study suggests a careful analysis and evaluation of the software platform before purchase.