Intraoperative MRI and CT
Scanners built into or next to the operating theatre, so the surgeon can check during a brain tumour or spine operation how much tumour is left and remove more before closing.
Overview
Intraoperative MRI began in 1994 with an open magnet at Brigham and Women's Hospital in which the surgeon operated between two coils. Today the usual design is a high-field magnet in an adjoining room or a ceiling-mounted magnet that travels to the patient, with the operating table and instruments made MR-compatible. Its main use is glioma surgery: a randomised trial (Senft, Lancet Oncology 2011) showed that intraoperative MRI increased the rate of complete resection of contrast-enhancing tumour compared with conventional microsurgery, and it is also used for pituitary adenomas and paediatric brain tumours. Intraoperative CT, either a mobile cone-beam or fan-beam unit (Medtronic O-arm, Brainlab Airo, Samsung BodyTom) or a fixed scanner in a hybrid theatre, updates surgical navigation after the anatomy has shifted and confirms screw and implant placement in spinal and pelvic tumour surgery.
The cost is high: a dedicated suite, compatible instruments, longer operations and staff training, and the benefit is proven only for extent of resection, not directly for survival. Fluorescence-guided surgery with 5-ALA and intraoperative ultrasound are cheaper ways of answering the same question.
- Superconducting magnet bore
- RF coil / gradients
- Proton spins align
How it works
An MRI or CT scanner integrated with the operating suite acquires images during surgery so that residual tumour is seen and navigation is re-registered to the shifted anatomy before the operation is completed.
- More complete glioma resection in a randomised trial
- Updates navigation after brain shift
- Confirms implants in spinal tumour surgery
- Expensive suite and compatible instruments
- Longer operations
- No direct evidence of longer survival
Latest papers
topQuery for this technology: (TITLE:"Intraoperative MRI and CT" OR ABSTRACT:"Intraoperative MRI and CT") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Intraoperative MRI and CT, not a curated reading list.
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