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Sagittal fusion images. (A) Sagittal magnetic resonance imaging (MRI) obtained following gadolinium administration revealing two abnormal contrast-enhanced lesions located in the left basal ganglia areas. (B) Sagittal 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) fusion image revealing higher FDG uptake within the upper right lesion (white arrow) than in the lower left lesion (black arrow) and the compressed left corticospinal tract of the posterior limb of the internal capsule (black arrowhead). (C) Sagittal PET-MRI fusion image demonstrating the overlap of the areas of high FDG uptake and the contrast-enhanced lesion.
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Following the scan, the digital imaging data and pre-operative PET/CT data were transferred to the navigation planning workstation software, iPlan 3.0 (BrainLAB, Feldkirchen, Germany), for automatic multi-image fusion (Fig. 1A-C).
BrainLAB planning software was used to reconstruct the corticospinal tracts (CST) and reveal the three-dimensional (3D) anatomical association between the CST and the brain lesions, according to the 18F-fluorodeoxyglucose-positron emission tomography (PET) and contrast-enhanced magnetic resonance imaging (MRI) fusion images. (A) MRI-diffusion tensor imaging (DTI) fusion image revealing the 3D association between the lesion and the CST. (B) PET-DTI fusion image revealing the 3D association between the lesion and the CST.
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The software was then used to generate the three-dimensional (3D) objects, which displayed the anatomical association between the CST and the brain lesions (Fig. 2A and B).
Comparision of pre-operative and intraoperative contrast-enhanced magnetic resonance imaging (MRI) images. (A) The ideal target site and a reasonable needle track were identified using the Leksell stereotaxic planning system. (B) The intraoperative MRI (iMRI) image revealing the biopsy trajectory (white arrow). Immediate iMRI identified no surgical bleeding, and the biopsy trajectory reached the target site (black arrow).
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Using the Leksell stereotaxic planning system, the ideal target site, a reasonable needle track (Fig. 3A) and the final target and trajectory coordinates of the stereotactic FDG-PET and contrast-enhanced MRI fusion images were identified. The immediate post-operative MRI identified no surgical bleeding or other complications, and comparison of the pre-operative planning imaging was performed to ensure that the target biopsy trajectory had been achieved (Fig. 3B).