Neuroimaging clinics of North America
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Diffuse axonal shear injury is a common traumatic brain injury, with significant neurologic and behavioral impact on patients. Radiologic recognition of this entity and understanding of its sequelae can be of utmost importance in the prediction of outcome and planning for rehabilitation. MRI has proven to be the optimal means of detection and characterization of DAI lesions, with GRE and FLAIR sequences being particularly helpful, and more advanced techniques such as MRS show preliminary evidence of some utility in determining outcome.
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Neuroimaging Clin. N. Am. · Nov 2001
ReviewThermal therapies in interventional MR imaging. Focused ultrasound.
MR image-guided focused ultrasound (FUS) provides an entirely noninvasive approach for local thermal therapies. MR imaging allows target definition and continuous temperature mapping. ⋯ Phased-array ultrasound technology will further help the development. MR imaging/FUS may be applied not only for tissue ablation, but also for local drug delivery, gene therapy, and drug activation.
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Neuroimaging Clin. N. Am. · Nov 2001
ReviewOptimizing brain tumor resection. Midfield interventional MR imaging.
The development of the intraoperative MR imager represents an important example of creative vision and interdisciplinary teamwork. The result is a remarkable tool for neurosurgical applications. MRT allows surgical manipulation under direct visualization of the intracranial contents through the eye of the surgeon and through the volumetric images of the MR imaging system. ⋯ Those limits are much tighter around the domain of tool manipulation, where the surgeon will yield, early on, to the enhanced performance of robotics and other technical adjuncts. The era of large open magnet imaging systems for surgical procedures then will come to a close; however, the grander era of the surgeon's integration of precision-guided, multimodality therapeutics will just be beginning. The future will be very bright, indeed.
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The role of imaging in diagnosis and therapy has been accepted by physicians. This favorable reception of minimally invasive procedures resulted in the recognition of the feasibility of image-guided approaches. ⋯ The current trend is the evolution of integrated therapy delivery systems in which advanced imaging modalities are closely linked with high performance computing. Obviously, the operating room of the future will accommodate various instruments, tools and devices, which are attached to the imaging systems and controlled by image-based feedback.
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Laser ablation of cerebral tumors is an alternative to surgical excision and radiosurgery; however, more clinical testing is necessary. Various MR parameters can be used during laser ablation to detect structural as well as temperature changes in near real-time for diagnostic and therapeutic applications. Unfortunately, MR-guided ablation does not solve the problem of defining a precise target in high-grade tumors of the central nervous system.