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

Authors :
Sophie Lombardi
Domenico Tortora
Stefania Picariello
Sniya Sudhakar
Enrico De Vita
Kshitij Mankad
Sophia Varadkar
Alessandro Consales
Lino Nobili
Jessica Cooper
Martin M. Tisdall
Felice D’Arco
Source :
Diagnostics, Vol 13, Iss 14, p 2331 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

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.

Details

Language :
English
ISSN :
20754418
Volume :
13
Issue :
14
Database :
Directory of Open Access Journals
Journal :
Diagnostics
Publication Type :
Academic Journal
Accession number :
edsdoj.8949ba996e074a768d3da84f18b17877
Document Type :
article
Full Text :
https://doi.org/10.3390/diagnostics13142331