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Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma

Laser ablation for treatment of hypothalamic hamartoma (HH) is a minimally invasive and effective technique used to destroy hamartomatous tissue and disconnect it from the functioning brain. Currently, the gold standard to evaluate the amount of tissue being “burned” is the use of heat maps during t...

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Autores principales: Lombardi, Sophie, Tortora, Domenico, Picariello, Stefania, Sudhakar, Sniya, De Vita, Enrico, Mankad, Kshitij, Varadkar, Sophia, Consales, Alessandro, Nobili, Lino, Cooper, Jessica, Tisdall, Martin M., D’Arco, Felice
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378573/
https://www.ncbi.nlm.nih.gov/pubmed/37510075
http://dx.doi.org/10.3390/diagnostics13142331
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author Lombardi, Sophie
Tortora, Domenico
Picariello, Stefania
Sudhakar, Sniya
De Vita, Enrico
Mankad, Kshitij
Varadkar, Sophia
Consales, Alessandro
Nobili, Lino
Cooper, Jessica
Tisdall, Martin M.
D’Arco, Felice
author_facet Lombardi, Sophie
Tortora, Domenico
Picariello, Stefania
Sudhakar, Sniya
De Vita, Enrico
Mankad, Kshitij
Varadkar, Sophia
Consales, Alessandro
Nobili, Lino
Cooper, Jessica
Tisdall, Martin M.
D’Arco, Felice
author_sort Lombardi, Sophie
collection PubMed
description Laser ablation for treatment of hypothalamic hamartoma (HH) is a minimally invasive and effective technique used to destroy hamartomatous tissue and disconnect it from the functioning brain. Currently, the gold standard to evaluate the amount of tissue being “burned” is the use of heat maps during the ablation procedure. However, these maps have low spatial resolution and can be misleading in terms of extension of the tissue damage. The aim of this study is to use different MRI sequences immediately after each laser ablation and correlate the extension of signal changes with the volume of malacic changes in a long-term follow-up scan. During the laser ablation procedure, we imaged the hypothalamic region with high-resolution axial diffusion-weighted images (DWI) and T2-weighted images (T2WI) after each ablation. At the end of the procedure, we also added a post-contrast T1-weighted image (T1WI) of the same region. We then correlated the product of the maximum diameters on axial showing signal changes (acute oedema on T2WI, DWI restriction rim, DWI hypointense core and post-contrast T1WI rim) with the product of the maximum diameters on axial T2WI of the malacic changes in the follow-up scan, both as a fraction of the total area of the hamartoma. The area of the hypointense core on DWI acquired immediately after the laser ablation statistically correlated better with the final area of encephalomalacia, while the T2WI, hyperintense oedema, DWI rim and T1WI rim of enhancement tended to overestimate the encephalomalacic damage. In conclusion, the use of intraoperative sequences (in particular DWI) during laser ablation can give surgeons valuable information in real time about the effective heating damage on the hamartomatous tissue, with better spatial resolution in comparison to the thermal maps.
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spelling pubmed-103785732023-07-29 Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma Lombardi, Sophie Tortora, Domenico Picariello, Stefania Sudhakar, Sniya De Vita, Enrico Mankad, Kshitij Varadkar, Sophia Consales, Alessandro Nobili, Lino Cooper, Jessica Tisdall, Martin M. D’Arco, Felice Diagnostics (Basel) Article Laser ablation for treatment of hypothalamic hamartoma (HH) is a minimally invasive and effective technique used to destroy hamartomatous tissue and disconnect it from the functioning brain. Currently, the gold standard to evaluate the amount of tissue being “burned” is the use of heat maps during the ablation procedure. However, these maps have low spatial resolution and can be misleading in terms of extension of the tissue damage. The aim of this study is to use different MRI sequences immediately after each laser ablation and correlate the extension of signal changes with the volume of malacic changes in a long-term follow-up scan. During the laser ablation procedure, we imaged the hypothalamic region with high-resolution axial diffusion-weighted images (DWI) and T2-weighted images (T2WI) after each ablation. At the end of the procedure, we also added a post-contrast T1-weighted image (T1WI) of the same region. We then correlated the product of the maximum diameters on axial showing signal changes (acute oedema on T2WI, DWI restriction rim, DWI hypointense core and post-contrast T1WI rim) with the product of the maximum diameters on axial T2WI of the malacic changes in the follow-up scan, both as a fraction of the total area of the hamartoma. The area of the hypointense core on DWI acquired immediately after the laser ablation statistically correlated better with the final area of encephalomalacia, while the T2WI, hyperintense oedema, DWI rim and T1WI rim of enhancement tended to overestimate the encephalomalacic damage. In conclusion, the use of intraoperative sequences (in particular DWI) during laser ablation can give surgeons valuable information in real time about the effective heating damage on the hamartomatous tissue, with better spatial resolution in comparison to the thermal maps. MDPI 2023-07-10 /pmc/articles/PMC10378573/ /pubmed/37510075 http://dx.doi.org/10.3390/diagnostics13142331 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lombardi, Sophie
Tortora, Domenico
Picariello, Stefania
Sudhakar, Sniya
De Vita, Enrico
Mankad, Kshitij
Varadkar, Sophia
Consales, Alessandro
Nobili, Lino
Cooper, Jessica
Tisdall, Martin M.
D’Arco, Felice
Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma
title Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma
title_full Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma
title_fullStr Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma
title_full_unstemmed Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma
title_short Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma
title_sort intraoperative mri assessment of the tissue damage during laser ablation of hypothalamic hamartoma
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378573/
https://www.ncbi.nlm.nih.gov/pubmed/37510075
http://dx.doi.org/10.3390/diagnostics13142331
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