Implications of Extracranial Distortion in Ultra-High-Field Magnetic Resonance Imaging for Image-Guided Cranial Neurosurgery

BACKGROUND:Ultra-high-field magnetic resonance imaging (MRI) of the brain is attractive for image guidance during neurosurgery because of its high tissue contrast and detailed vessel visualization. However, high-field MRI is prone to distortion artifacts, which may compromise image guidance. Here we investigate intra- and extracranial distortions in 7-T MRI scans. METHODS:Five patients with and 5 patients without skin-adhesive fiducials received magnetization-prepared T1-weighted 7-T MRI and standard 3-T MRI scans. The 7- and 3-T images were rigidly coregistered and compared. Intracranial distortions were evaluated qualitatively, whereas shifts at the skin surface and shifts of the center positions of skin-adhesive fiducials were measured quantitatively. Moreover, we present an illustrative case of an ultra-high-field image-guided skull base meningioma resection. RESULTS:We found excellent intracranial correspondence between 3- and 7-T MRI scans. However, the average maximum skin shift was 6.8 ± 2.0 mm in group A and 5.2 ± 0.9 mm in group B. The average maximum difference between the skin-adhesive fiducial positions was 5.6 ± 3.1 mm in group B. In our tumor resection case, the meningioma blood supply could be targeted early thanks to 7-T image guidance, which made subsequent tumor removal straightforward. CONCLUSIONS:There are no visible intracranial distortions in magnetization-prepared T1-weighted 7-T MRI cranial images. However, we found considerable extracranial shifts. These shifts render 7-T images unreliable for patient-to-image registration. We recommend performing patient-to-image registration on a routine (computed tomography scan or 3-T magnetic resonance) image and subsequently fusing the 7-T magnetic resonance image with the routine image on the image guidance machine, until this issue is resolved.