Department of Radiology, BWH

Transcript Department of Radiology, BWH

Surgical Planning Laboratory Brigham and Women’s Hospital Boston, Massachusetts USA a teaching affiliate of Harvard Medical School

Visit of Barbara Alving, M.D. 8-15 05

Ron Kikinis, M.D.

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

Schedule

• Prostate • Neurosurgery • NCRR portfolio • Discussion

Prostate

Neurosurgery

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

• • • Intra-operative MRI at BWH Craniotomy=699 Brain biopsy=180 LASER ablation=9 • • Transsphenoidal pituitary adenoma resection Total=918

MRT allows surgeon to visualize resection progress and brain shift

F. Talos

Functional MRI can provide a pre-operative map of critical brain areas

• Motor, visual cortex well demonstrated • Language lateralization • Increasingly, language localization and memory

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 Lower diffusion across fiber axons Higher diffusion along fiber

Stimulation mapping to locate essential cortical areas

Fiber tracts

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Image coregistration and fusion

Intraoperative image fusion and display: fMRI and Cortical Stimulation

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

NCRR portfolio

Research Interactions between NA-MIC, NAC, BIRN

BIRN

Focus: infrastructure, data, data distribution

e.g. Provides shared image databases and high speed network/computing for NA-MIC & NAC NA-MIC

Data Requirements, testing, tools

Focus: algorithms, engineering, general software tools

e.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

Data repositories and access Advances in medical image computing

NAC

Focus: specific applications, custom software tools

e.g. Tensor analysis for pioneering diffusion technology from BWH

Local Level Science National Level Outreach

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