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Image Fusion for Radiosurgery, Neurosurgery and Hypofractionated Radiotherapy.

Inoue HK, Nakajima A, Sato H, Noda SE, Saitoh J, Suzuki Y - Cureus (2015)

Bottom Line: All images are fused and registered on thin sliced CT sections and exactly demarcated targets are planned for treatment.Follow-up images are also able to register on this CT.Exact target changes, including volume, are possible in this fusion system.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept of Neurosurgery and Radiation Oncology, Institute of Neural Organization and Cyber Center, Kanto Neurosurgical Hospital.

ABSTRACT
Precise target detection is essential for radiosurgery, neurosurgery and hypofractionated radiotherapy because treatment results and complication rates are related to accuracy of the target definition. In skull base tumors and tumors around the optic pathways, exact anatomical evaluation of cranial nerves are important to avoid adverse effects on these structures close to lesions. Three-dimensional analyses of structures obtained with MR heavy T2-images and image fusion with CT thin-sliced sections are desirable to evaluate fine structures during radiosurgery and microsurgery. In vascular lesions, angiography is most important for evaluations of whole structures from feeder to drainer, shunt, blood flow and risk factors of bleeding. However, exact sites and surrounding structures in the brain are not shown on angiography. True image fusions of angiography, MR images and CT on axial planes are ideal for precise target definition. In malignant tumors, especially recurrent head and neck tumors, biologically active areas of recurrent tumors are main targets of radiosurgery. PET scan is useful for quantitative evaluation of recurrences. However, the examination is not always available at the time of radiosurgery. Image fusion of MR diffusion images with CT is always available during radiosurgery and useful for the detection of recurrent lesions. All images are fused and registered on thin sliced CT sections and exactly demarcated targets are planned for treatment. Follow-up images are also able to register on this CT. Exact target changes, including volume, are possible in this fusion system. The purpose of this review is to describe the usefulness of image fusion for 1) skull base, 2) vascular, 3) recurrent target detection, and 4) follow-up analyses in radiosurgery, neurosurgery and hypofractionated radiotherapy.

No MeSH data available.


Related in: MedlinePlus

A brain arteriovenous malformation.MR angiography showing a large AVM in the left frontal lobe (upper left). The 3-D reconstruction from axial images of rotation angiography (lower left) showing the nidus (small arrow) and massive draining veins (large arrows) in the frontal base. Dose plan targeting of the nidus, excluding massive drainers, on axial images of the angiogram (AG) fused to those of CT angiogram (CTA) and enhanced MR angiogram (MRA).
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FIG9: A brain arteriovenous malformation.MR angiography showing a large AVM in the left frontal lobe (upper left). The 3-D reconstruction from axial images of rotation angiography (lower left) showing the nidus (small arrow) and massive draining veins (large arrows) in the frontal base. Dose plan targeting of the nidus, excluding massive drainers, on axial images of the angiogram (AG) fused to those of CT angiogram (CTA) and enhanced MR angiogram (MRA).

Mentions: Total obliteration without functional deficits is the goal of AVM treatment [14]. The nidus delineation, excluding feeder and draining veins, is important during dose planning for radiosurgery. The 3-D vascular structures of AVMs are reconstructed to detect the nidus from rotation angiography (Figure 1). Intranidal fine pathologies, such as arteriovenous shunts, small aneurysms, and varices, can be evaluated even after intervention. True image fusion angiography to CT (axial slice CT angiography) and MR images, including contrast-enhanced MR angiography, enables the detection of tiny pathologies and complicated targets after intravascular intervention. These targets are difficult to detect with conventional methods using stereotactic multidirectional angiography. Exact nidus detection is important for radiosurgery to avoid complications due to overdoses to the surrounding brain, especially in cases of large AVMs (Figure 9).


Image Fusion for Radiosurgery, Neurosurgery and Hypofractionated Radiotherapy.

Inoue HK, Nakajima A, Sato H, Noda SE, Saitoh J, Suzuki Y - Cureus (2015)

A brain arteriovenous malformation.MR angiography showing a large AVM in the left frontal lobe (upper left). The 3-D reconstruction from axial images of rotation angiography (lower left) showing the nidus (small arrow) and massive draining veins (large arrows) in the frontal base. Dose plan targeting of the nidus, excluding massive drainers, on axial images of the angiogram (AG) fused to those of CT angiogram (CTA) and enhanced MR angiogram (MRA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494462&req=5

FIG9: A brain arteriovenous malformation.MR angiography showing a large AVM in the left frontal lobe (upper left). The 3-D reconstruction from axial images of rotation angiography (lower left) showing the nidus (small arrow) and massive draining veins (large arrows) in the frontal base. Dose plan targeting of the nidus, excluding massive drainers, on axial images of the angiogram (AG) fused to those of CT angiogram (CTA) and enhanced MR angiogram (MRA).
Mentions: Total obliteration without functional deficits is the goal of AVM treatment [14]. The nidus delineation, excluding feeder and draining veins, is important during dose planning for radiosurgery. The 3-D vascular structures of AVMs are reconstructed to detect the nidus from rotation angiography (Figure 1). Intranidal fine pathologies, such as arteriovenous shunts, small aneurysms, and varices, can be evaluated even after intervention. True image fusion angiography to CT (axial slice CT angiography) and MR images, including contrast-enhanced MR angiography, enables the detection of tiny pathologies and complicated targets after intravascular intervention. These targets are difficult to detect with conventional methods using stereotactic multidirectional angiography. Exact nidus detection is important for radiosurgery to avoid complications due to overdoses to the surrounding brain, especially in cases of large AVMs (Figure 9).

Bottom Line: All images are fused and registered on thin sliced CT sections and exactly demarcated targets are planned for treatment.Follow-up images are also able to register on this CT.Exact target changes, including volume, are possible in this fusion system.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept of Neurosurgery and Radiation Oncology, Institute of Neural Organization and Cyber Center, Kanto Neurosurgical Hospital.

ABSTRACT
Precise target detection is essential for radiosurgery, neurosurgery and hypofractionated radiotherapy because treatment results and complication rates are related to accuracy of the target definition. In skull base tumors and tumors around the optic pathways, exact anatomical evaluation of cranial nerves are important to avoid adverse effects on these structures close to lesions. Three-dimensional analyses of structures obtained with MR heavy T2-images and image fusion with CT thin-sliced sections are desirable to evaluate fine structures during radiosurgery and microsurgery. In vascular lesions, angiography is most important for evaluations of whole structures from feeder to drainer, shunt, blood flow and risk factors of bleeding. However, exact sites and surrounding structures in the brain are not shown on angiography. True image fusions of angiography, MR images and CT on axial planes are ideal for precise target definition. In malignant tumors, especially recurrent head and neck tumors, biologically active areas of recurrent tumors are main targets of radiosurgery. PET scan is useful for quantitative evaluation of recurrences. However, the examination is not always available at the time of radiosurgery. Image fusion of MR diffusion images with CT is always available during radiosurgery and useful for the detection of recurrent lesions. All images are fused and registered on thin sliced CT sections and exactly demarcated targets are planned for treatment. Follow-up images are also able to register on this CT. Exact target changes, including volume, are possible in this fusion system. The purpose of this review is to describe the usefulness of image fusion for 1) skull base, 2) vascular, 3) recurrent target detection, and 4) follow-up analyses in radiosurgery, neurosurgery and hypofractionated radiotherapy.

No MeSH data available.


Related in: MedlinePlus