The development of ultra–high field MRI guidance technology for neuronavigation

Aaron E. RusheenDepartment of Neurologic Surgery, Mayo Clinic, Rochester;
Medical Scientist Training Program, Mayo Clinic, Rochester;

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Abhinav GoyalDepartment of Neurologic Surgery, Mayo Clinic, Rochester;
Medical Scientist Training Program, Mayo Clinic, Rochester;

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Robert L. OwenMayo Clinic Alix School of Medicine, Mayo Clinic, Rochester;

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Elise M. BerningDepartment of Neurologic Surgery, Mayo Clinic, Rochester;

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Dane T. BothunDepartment of Neurologic Surgery, Mayo Clinic, Rochester;

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Rachel E. GiblonKern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester;

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Charles D. BlahaDepartment of Neurologic Surgery, Mayo Clinic, Rochester;

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Kirk M. WelkerDepartment of Radiology, Mayo Clinic, Rochester; and

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John Huston IIIDepartment of Radiology, Mayo Clinic, Rochester; and

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Kevin E. BennetDepartment of Neurologic Surgery, Mayo Clinic, Rochester;

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Yoonbae OhDepartment of Neurologic Surgery, Mayo Clinic, Rochester;

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Andrew J. FaganDepartment of Radiology, Mayo Clinic, Rochester; and
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota

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Kendall H. LeeDepartment of Neurologic Surgery, Mayo Clinic, Rochester;
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota

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OBJECTIVE

Magnetic resonance imaging at 7T offers improved image spatial and contrast resolution for visualization of small brain nuclei targeted in neuromodulation. However, greater image geometric distortion and a lack of compatible instrumentation preclude implementation. In this report, the authors detail the development of a stereotactic image localizer and accompanying imaging sequences designed to mitigate geometric distortion, enabling accurate image registration and surgical planning of basal ganglia nuclei.

METHODS

Magnetization-prepared rapid acquisition with gradient echo (MPRAGE), fast gray matter acquisition T1 inversion recovery (FGATIR), T2-weighted, and T2*-weighted sequences were optimized for 7T in 9 human subjects to visualize basal ganglia nuclei, minimize image distortion, and maximize target contrast-to-noise and signal-to-noise ratios. Extracranial spatial distortions were mapped to develop a skull-contoured image localizer embedded with spherical silicone fiducials for improved MR image registration and target guidance. Surgical plan accuracy testing was initially performed in a custom-developed MRI phantom (n = 5 phantom studies) and finally in a human trial.

RESULTS

MPRAGE and T2*-weighted sequences had the best measures among global measures of image quality (3.8/4, p < 0.0001; and 3.7/4, p = 0.0002, respectively). Among basal ganglia nuclei, FGATIR outperformed MPRAGE for globus pallidus externus (GPe) visualization (2.67/4 vs 1.78/4, p = 0.008), and FGATIR, T2-weighted imaging, and T2*-weighted imaging outperformed MPRAGE for substantia nigra visualization (1.44/4 vs 2.56/4, p = 0.04; vs 2.56/4, p = 0.04; vs 2.67/4, p = 0.003). Extracranial distortion was lower in the head’s midregion compared with the base and apex ( 1.17–1.33 mm; MPRAGE and FGATIR, p < 0.0001; T2-weighted imaging, p > 0.05; and T2*-weighted imaging, p = 0.013). Fiducial placement on the localizer in low distortion areas improved image registration (fiducial registration error, 0.79–1.19 mm; p < 0.0001) and targeting accuracy (target registration error, 0.60–1.09 mm; p = 0.04). Custom surgical software and the refined image localizer enabled successful surgical planning in a human trial (fiducial registration error = 1.0 mm).

CONCLUSIONS

A skull-contoured image localizer that accounts for image distortion is necessary to enable high-accuracy 7T imaging–guided targeting for surgical neuromodulation. These results may enable improved clinical efficacy for the treatment of neurological disease.

ABBREVIATIONS

BWr = receiver bandwidth; B0 = static magnetic field; B1 = RF field; CNR = contrast-to-noise ratio; DBS = deep brain stimulation; FGATIR = fast gray matter acquisition T1 inversion recovery; GPe = globus pallidus externus; GPi = globus pallidus internus; MPRAGE = magnetization-prepared rapid acquisition with gradient echo; RF = radiofrequency; RMSE = root mean square error; SN = substantia nigra; SNR = signal-to-noise ratio; STN = subthalamic nucleus.

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Illustration from Xu et al. (pp 1418–1430). With permission from Juan Carlos Fernandez-Miranda and The Neurosurgical Atlas by Aaron Cohen-Gadol.

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