Multimodal Registration of the Brain's Cortical Surface

描述(申请人提供)：就现有患者群体而言，预计2013年将诊断出约69,720例新的原发脑肿瘤病例，其中约35%为恶性肿瘤。在20岁以下的儿童和20-30岁的男性中，脑瘤是导致癌症相关死亡的第二大原因。有趣的是，发达国家的发病率要高得多，大约高出70%。诊断为原发性脑瘤后的五年存活率平均约为33.8%，但随年龄的变化很大(例如，65岁以上的人为10%)。根据国家癌症研究所的说法，手术切除是大多数脑肿瘤的推荐治疗方法，目标是在保留神经功能的同时尽可能完整地切除肿瘤。就国家神经疾病和中风研究所的使命而言，更彻底的切除通过恢复功能、延长生命和提高生活质量来减轻神经疾病的负担。在外科治疗方面， 将患者暴露在手术室(OR)内的大脑与术前获得的神经解剖图像联系起来的视觉显示器已经变得司空见惯。更具体地说，外科医生可以使用笔状的触控笔指向患者脑组织上的特定特征，并通过交互式显示来查看该组织在神经解剖图像上的位置。这一过程的一个不利之处是，患者的大脑因常见的手术操作而变形。结果，图像和患者的物理大脑之间的对准受到损害，可能会接踵而至的手术错误。在该奖项的第1-7年(首次提交和首次续展)中，我们已经展示了术中获得的皮质表面几何数据可以用于：改善图像与患者的对准，测量手术中的脑变形，并在图像引导的神经外科手术中驱动计算方法来纠正脑移位。在本申请中，我们采取了广泛的术中验证和独立测试的最后一步。需要检验的假设是，当计算机模型、皮质表面几何数据和跟踪触针数字化技术用于补偿图像引导的脑肿瘤手术中的变形时，可以预测有说服力的脑周围病变的位置，因此这种方法是术中磁共振(IMR)成像的有效替代物。具体目的是：(1)在手术显微镜和商业指导环境中集成一种新的基于计算机视觉的手术视野数字化方法，使得所获取的数据可以驱动基于计算机模型的方法来校正变形的显示，(2)与来自布里格姆和妇女医院的独立合作者亚历克斯·戈尔比博士进行20名患者的回顾性验证研究，将我们的皮质表面变形驱动补偿管道的结果与通过“黄金标准”IMR成像方法获得的结果进行比较，(3)分别在Vanderbilt和Brigham进行两项前瞻性的20名患者研究，并评估术中工作流程，以及在有IMR替代方案的情况下和在没有IMR替代方案的情况下在机构中校正显示的有效性。关于这项工作的重要性，在很大程度上，图像引导手术在软组织器官手术中的应用主要局限于颅脑环境，人们普遍认为脑部移位是一个问题。随着这种低成本、负担最小的解决方案解决了畸形，将影像引导手术转化为其他软组织器官的能力可能会变得司空见惯。此外，与术中成像方法(例如MR)相比，这里的方法是便宜的，并且是可扩展的，即能够被广泛采用。这一应用在为更广泛的患者群体提供所需的替代品方面可能具有开创性意义，这些患者可以受益于改进的‘变形矫正’指导，但可能无法使用IMR设施。

DESCRIPTION (provided by applicant): With respect to the presenting patient population, approximately 69,720 new cases of primary brain tumors are expected to be diagnosed in 2013 with approximately 35% of those tumors being malignant. Brain tumors are the second leading cause of cancer-related deaths in children under age 20, and males between the ages of 20-30. Interestingly, incidence rates are significantly higher in developed countries, approximately 70% higher. Five year survival rates following diagnosis of a primary brain tumor is approximately 33.8% on average but vary considerably with age (e.g. over the age of 65 is 10%). According to the National Cancer Institute surgical removal is the recommended treatment for most brain tumors with the goal of the most complete resection possible while preserving neurological function. With respect to the mission of the National Institute for Neurological Disorders and Stroke, more complete resection reduces the burden of neurological disease by restoring function, extending life, and improving the quality of that life. With respect to surgical therapy, the deployment of visual displays that relate the patient's exposed brain within the operating room (OR) to the pre- operatively acquired neuroanatomical images has become commonplace. More specifically, surgeons can use a pen-like stylus to point at a specific feature on the patient's brain tissue and see where that tissue resides on the neuroanatomical images as facilitated by an interactive display. One detriment to this process is when the patient's brain deforms due to common surgical manipulations. As a result, the alignment between images and the patient's physical brain becomes compromised and surgical error could ensue. Over years 1-7 of this award (initial submission & first renewal), we have demonstrated that intraoperatively acquired cortical surface geometric data can be used to: improve image-to-patient alignment, measure brain deformations during surgery, and drive a computational approach to brain shift correction during image-guided neurosurgery. In this application, we take the final step of extensive intraoperative validation and independent testing. The hypothesis to be tested is that computer models, cortical surface geometric data, and tracked stylus digitization technology when used to compensate for deformation during image-guided brain tumor surgery can predict the locations of eloquent brain surround pathology such that this approach is an effective surrogate to intraoperative magnetic resonance (iMR) imaging. The specific aims to accomplish this are to: (1) integrate a novel computer-vision based approach to surgical field digitization within the surgical microscope and commercial guidance environment such that acquired data can drive a computer model-based approach to correct displays for deformations, (2) conduct a 20 patient retrospective validation study with independent collaborator Dr. Alex Golby of Brigham and Women's hospital comparing the results from our cortical surface deformation driven compensation pipeline to that acquired by the "gold standard" iMR imaging approach, (3) conduct two prospective 20 patient studies at Vanderbilt and the Brigham respectively, and evaluate intraoperative workflow, as well as the efficacy of corrected displays at institutions wit and without the presence of the iMR alternative. With respect to the importance of this work, in large part, the use of image-guided surgery for surgical resection in soft-tissue organs has been confined primarily to the cranial environment with the common understanding that 'brain shift' is a problem. With the resolution of deformations by this low-cost minimally encumbered solution, the ability to translate image-guided surgery to other soft- tissue organs could become commonplace. Furthermore, the approaches herein are inexpensive when compared to intra-operative imaging methods (e.g. MR), and scalable, i.e. capable of widespread adoption. This application could be seminal in providing the needed surrogate for the wider populations of patient that could benefit from improved 'deformation corrected' guidance but may not have access to iMR facilities.