Surgical Planning LaboratoryBrigham and Women’s HospitalBoston, Massachusetts USA

a teaching affiliate ofHarvard Medical School

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

Ron Kikinis, M.D.

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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

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Schedule

• Prostate

• Neurosurgery

• NCRR portfolio

• Discussion

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Prostate

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Neurosurgery

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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

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Intra-operative MRI at BWH

• Craniotomy=699

• Brain biopsy=180

• LASER ablation=9

• Transsphenoidal pituitary adenoma resection

• Total=918

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MRT allows surgeon to visualize resection progress and brain shift

F. Talos

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• Motor, visual cortex well demonstrated

• Language lateralization

• Increasingly, language localization and memory

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

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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

Higher diffusionalong fiber

Lower diffusion across fiber

axons

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Stimulation mapping to locate essential cortical areas

Fiber tracts

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Image coregistration and fusion

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Intraoperative image fusion and display: fMRI and Cortical Stimulation

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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

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NCRR portfolio

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NACFocus: specific applications,

custom software toolse.g. Tensor analysis for

pioneering diffusion technology from BWH

BIRNFocus: infrastructure, data,

data distributione.g. Provides shared image databases and

high speed network/computing for NA-MIC & NAC

NA-MICFocus: algorithms, engineering,

general software toolse.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

Advances in medical image computingData repositories and access

Data

Requirements,testing, tools

Research Interactions between NA-MIC, NAC, BIRN

Local Level Science

National Level Outreach