Automatic rigid image Fusion of preoperative MR and intraoperative US acquired after craniotomy

BACKGROUND: Neuronavigation of preoperative MRI is limited by several errors. Intraoperative ultrasound (iUS) with navigated probes that provide automatic superposition of pre-operative MRI and iUS and three-dimensional iUS reconstruction may overcome some of these limitations. Aim of the present study is to verify the accuracy of an automatic MRI – iUS fusion algorithm to improve MR-based neuronavigation accuracy. METHODS: An algorithm using Linear Correlation of Linear Combination (LC2)-based similarity metric has been retrospectively evaluated for twelve datasets acquired in patients with brain tumor. A series of landmarks were defined both in MRI and iUS scans. The Target Registration Error (TRE) was determined for each pair of landmarks before and after the automatic Rigid Image Fusion (RIF). The algorithm has been tested on two conditions of the initial image alignment: registration-based fusion (RBF), as given by the navigated ultrasound probe, and different simulated course alignments during convergence test. RESULTS: Except for one case RIF was successfully applied in all patients considering the RBF as initial alignment. Here, mean TRE after RBF was significantly reduced from 4.03 (± 1.40) mm to (2.08 ± 0.96 mm) (p = 0.002), after RIF. For convergence test, the mean TRE value after initial perturbations was 8.82 (± 0.23) mm which has been reduced to a mean TRE of 2.64 (± 1.20) mm after RIF (p < 0.001). CONCLUSIONS: The integration of an automatic image fusion method for co-registration of pre-operative MRI and iUS data may improve the accuracy in MR-based neuronavigation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40644-023-00554-x.