Rapid Analysis of Intraoperatively Acquired DTI for Identification of Key White M

描述（由申请人提供）：手术切除是脑肿瘤最重要的治疗方法。当肿瘤位于关键的大脑区域，如运动、感觉或语言功能附近时，完全切除的目标必须与保留功能的目标相平衡。对关键的白质连接或神经束的损伤会使患者出现严重的神经功能缺损。然而，在手术过程中，外科医生的眼睛看不到这些束，它们的稠度可能与肿瘤相同。因此，脑肿瘤的外科治疗可以从更完整、准确的脑结构功能图中获益良多。弥散张量MRI （Diffusion tensor MRI， DTI）是一种相对较新的对脑白质结构敏感的MRI方式。该项目旨在将当前的DTI研究转化为手术室，以解决手术中白质束识别的挑战。该项目的长期目标是改善神经外科的白质制图，并增加我们对神经外科对白质影响的理解。白质束的运动轨迹可以用扩散张量DTI束影术来绘制。但是，由于在一个称为虚拟剥离的过程中必须选择感兴趣的束进行观察，每个束可能需要10分钟，因此术中DTI束造影的临床应用范围受到限制。大多数情况下，每个病人只有一个关键的通道被绘制出来。我们假设，通过使用患者自己的大脑作为参考，即利用患者个性化手术计划中包含的关键神经束的患者特异性模型，我们可以在手术中扫描患者时快速准确地生成更新的脑图。我们将开发一个软件系统，在神经外科手术过程中实时生成白质脑图，我们将进行两项验证研究来检验我们的假设。我们提出以下目标，将利用我们最新的最先进的，高场强术中3T MRI系统和我们的研究神经导航软件平台，3D切片机。(1)开发并优化术中DTI关键纤维束快速识别的计算方法。这部分的项目将集中在数学发展的通道相似度量，以及软件的设计和实现。(2)通过在手术室中进行多重评估和电刺激来验证系统的速度和准确性。该项目的这一部分将集中在神经外科医生和神经放射学家对该系统的临床验证上，这将使我们能够测试我们最初的假设，即我们可以在手术过程中快速创建准确的脑白质图。

DESCRIPTION (provided by applicant): Surgical removal, or resection, is the most important treatment for brain tumors. When tumors are located near critical brain areas such as motor, sensory, or language functions, the goal of complete resection must be balanced with the goal of preservation of function. Injury to critical white matter connections, or tracts, will leave the patient with serious neurological deficits. However, during surgery, the tracts are not visible to the surgeon's eye, and their consistency may be the same as the tumor. Thus, the surgical treatment of brain tumors can benefit tremendously from more complete, accurate structural-functional brain maps. Diffusion tensor MRI (DTI) is a relatively new MRI modality that is sensitive to the structure of the white matter. This project aims to translate current DTI research into the operating room to address challenges of white matter tract identification during surgery. The long-term objectives of this project are to improve white matter mapping for neurosurgery and to increase our understanding of the effect of neurosurgery on the white matter. The trajectories of the white matter tracts can be mapped using diffusion tensor DTI tractography. But because the tracts of interest must be selected for viewing in a process called virtual dissection that can take 10 minutes per tract, the clinical use of intraoperative DTI tractography has been limited in scope. Most often only one crucial tract has been mapped per patient. We hypothesize that by using the patient's own brain as a reference, i.e. by taking advantage of patient-specific models of crucial tracts contained in their personalized surgical plan, we can quickly and accurately produce an updated brain map when the patient is scanned during surgery. We will develop a software system to produce the white matter brain map on the fly during neurosurgery, and we will perform two validation studies to test our hypothesis. We propose the following objectives that will take advantage of our new state-of-the-art, high field strength intraoperative 3T MRI system and our research neuronavigation software platform, 3D Slicer. (1) Develop and optimize computational methods for rapid identification of crucial fiber tracts in intraoperative DTI. This part of the project will focus on mathematical development of tract similarity measures, and on software design and implementation. (2) Validate speed and accuracy of the system via a multi-rater study and electrical stimulation in the OR. This part of the project will focus on clinical validation of the system by a neurosurgeon and neuroradiologist, and it will allow us to test our original hypothesis that we can quickly create an accurate brain map for the white matter during surgery. PUBLIC HEALTH RELEVANCE: In neurosurgery for brain tumors, the surgeon's aim is to remove as much as possible of the brain tumor while preserving crucial areas of the brain, including gray matter cortex and white matter connections. Thus, the surgical treatment of brain tumors can benefit tremendously from more complete, accurate structural-functional brain maps. The goal of this project is to quickly provide an updated accurate map of the brain's white matter connections to the neurosurgeon during brain surgery.