Remotely viewed MR images are helping neuroradiologists guide surgeons during brain surgery. The brain changes shape as structures shift during neurosurgery, making navigation less accurate as the procedure progresses. Obtaining MR scans during surgery
Remotely viewed MR images are helping neuroradiologists guide surgeons during brain surgery.
The brain changes shape as structures shift during neurosurgery, making navigation less accurate as the procedure progresses. Obtaining MR scans during surgery enables surgeons to judge the results of their efforts. When removing a tumor, for instance, the neurosurgeon can see how much tumor has been removed and the locations of remaining tumor tissue. More than 200 of these interventional MR procedures have been performed at the University of California, Los Angeles.
According to Dr. Gregory J. Rubino, director of interventional MR at UCLA, neurosurgery performed with MR guidance offers superior definition of brain anatomy and the relationships between critical normal structures and the surgical lesion. This permits accurate lesion localization with smaller, more focused craniotomies, which limit surgical risk to normal brain. It also enables assessment of the extent of tumor resection and diagnosis and treatment of intraoperative complications prior to wound closure, thereby decreasing the chance of permanent neurological injury.
But neurosurgeons, who are not necessarily expert at interpreting MR scans in all cases, sometimes require collaboration with neuroradiologists. When this is necessary the surgical procedure stops, the radiologist is paged and everyone - surgical team and anesthetized patient - wait for the neuroradiologist to arrive.
"Waiting drives the cost of surgery up because they charge by the hour," said Keyvan Farahani, Ph.D., an assistant professor of radiological sciences at UCLA. "Plus, the radiologist has to interrupt his or her work to come to the OR. Proper utilization of MRI in neurosurgical guidance requires real-time consultation with a neuroradiologist on demand throughout a procedure that may take as long as eight hours."
Farahani's solution is a telecollaboration scheme that allows neurosurgeons to consult with neuroradiologists during all stages of MR-guided procedures.
The prototype system modifies PACS workstations by implementing "application sharing" to allow telecollaboration. With this capability radiologists anywhere on the network can view images and telecollaborate with the surgeon in the OR, Farahani said. The radiologist can remotely navigate through the images, annotate them, make notes, prescribe imaging techniques, and interact with the surgeons, all in real-time.
"Teleconferencing has been used in medicine before, but this is crucial application because here you have a patient on the table and you're using high-tech medicine to treat them," Farahani said. "But you don't want the surgeon overwhelmed with hundreds of MR images when only a few are necessary. We want the surgeon to be able to concentrate on the surgery. This is why we need neuroradiologist presence."
SNMMI: Can 18F-Fluciclovine PET/CT Bolster Detection of PCa Recurrence in the Prostate Bed?
June 24th 2025In an ongoing prospective study of patients with biochemical recurrence of PCa and an initial negative PSMA PET/CT, preliminary findings revealed positive 18F-fluciclovine PET/CT scans in over 54 percent of the cohort, according to a recent poster presentation at the SNMMI conference.
Could an Emerging PET Tracer be a Game Changer for Detecting Hepatocellular Carcinoma?
June 23rd 2025In addition to over 90 percent sensitivity in detecting hepatocellular carcinoma (HCC), the glypican-3 (GPC3) targeted PET tracer 68Ga-aGPC3-scFv appeared to be advantageous in identifying HCC tumors smaller than one centimeter, according to pilot study findings presented at the SNMMI conference.
SNMMI: What a New Meta-Analysis Reveals About Radiotracers for PET/CT Detection of PCa
June 22nd 2025While (68Ga)Ga-PSMA-11 offers a pooled sensitivity rate of 92 percent for prostate cancer, (18F)-based radiotracers may offer enhanced lesion detection as well as improved imaging flexibility, according to a meta-analysis presented at the Society for Nuclear Medicine and Molecular Imaging (SNMMI) conference.