• Jin Kikuchi, Hideo Arai, Ryo Doi, Yasuharu Takeuchi, Ryoji Iwamoto, Hiroshi Nishimura, and Motohiro Morioka.
• Department of Neurosurgery, Fukuokaken Saiseikai Futsukaichi Hospital, Chikushino City, Fukuoka, Japan; Department of Neurosurgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan. Electronic address: d08sm040@outlook.jp.
• World Neurosurg. 2023 Jul 1; 175: e1075e1088e1075-e1088.

ObjectiveFor carotid endarterectomy (CEA) patients with renal dysfunction and allergies to contrast media, we developed a preoperative novel method of noncontrast 3-dimensional magnetic resonance fusion imaging (NC-3DMRFI) which could describe well blood vessels, plaques, and bony structures even in surgical position. In this study, we examined the usefulness of this method.MethodsWe extracted noncontrast magnetic resonance images of bones, blood vessels, and plaques to create a 3-dimensionalusion image. An image acquired in the normal position and another in the surgical position during CEA were used to create a fusion image. We compared the fusion imaging results with the intraoperative findings of 6 patients with contrast contraindications received CEA.ResultsPreoperative NC-3DMRFI could clearly show the positions of the carotid bifurcation, the distal end of plaque, and the bony structure in 5 of the 6 cases. Intraoperative findings and preoperative fusion imaging results were comparable in all cases where fusion images could be created. The fusion imaging in the surgical position during CEA was useful for preoperative examination, and the surgical space could be secured in the case of a high cervical location.ConclusionsThis pilot study showed our novel NC-3DMRFI method is useful for preoperative simulation in CEA, especially in patients with renal dysfunction and allergies to contrast media.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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