1. BRAIN SURFACE MOTION IMAGING FOR PREDICTION OF ADHESIONS BETWEEN MENINGIOMAS AND THE BRAIN SURFACE
Department of Radiology,
Nara Medical University, Nara, Japan
Toshiaki Taoka, Toshiaki Akashi, Toshiteru Miyasaka,
Hiroyuki Nakagawa, Masahiko Sakamoto, Kaoru Myochin, Katsutoshi Takayama, Kimihiko Kichikawa

2. Background
Adhesion between brain and extraaxial tumor such as meningioma is one of major cause for difficulty in surgical resection.
Pre-surgical prediction of adhesion between brain and meningioma will bring advantage for surgical planning.
“Brain surface motion imaging” is a method in which subtractions of images in systolic and diastolic phases of CSF/brain pulsatile motion are made.
Taoka T et al. Neuroradiology. 2010

3. Concept for Brain Motion Imaging
Systolic Diastolic
Band like texture:
Brain/CSF has moved
Subtraction

4. Purpose
The purpose of this study is to evaluate the feasibility of “Brain surface motion imaging” , which we developed to observe pulsatile motion of brain surface, for providing pre-surgical information about adhesion between meningioma and brain surface.

5. Subjects Meningioma 18 cases Falx 3 cases Parasagittal 6 cases
Convexity 3 cases
Frontal base 4 cases
Posterior fossa 2 cases
　34y.o to 75y.o（mean 63）
　Male 4 cases, Female 14 cases

6. Imaging Imager：1.5T clinical imager (Siemens Magnetom Avanto)
Pre-imaging：Phase-contrast cine MRI
(Velocity encoring=5cm/s, pulse gated)
Detect time phase in which CSH shows
highest and lowest signal intensity

7. Imaging Imaging: 3D heavily T2 weighted image (pulse gated)
(TR=2RR, TE=49, ETL=143, with SPACE)
Two sets of 3D images (systolic and diastolic)
Images of systolic and diastolic were processed by “Fusion” software (Siemens AG, Erlangen, Germany) for 3D motion correction and subtraction of the two sets of images.
Systolic
Diastolic
Brain surface motion image

8. Analysis
In the current study, we hypothesized that location with adhesion has simultaneous pulsatile motion between tumor and brain.
The presence of high and/or low signal band like texture surrounding meningioma will be an indicator of independent motion of tumor and brain. (i.e. absence of adhesion)

9. Analysis Band like texture on brain surface motion image：
Whole circumference Partial defect None
No adhesion Partial adhesion Diffuse adhesion

10. Analysis Agreement between following items >Conventional image
Presence and distribution of peritumoral band on T2WI
>Brain motion image
Presence and distribution of band like image
>Surgical findings
Presence and distribution of adhesion

11. Case 72F High convexity meningioma
Pre-surgical CE-MRI Brain surface motion image Post-surgical CE-MRI
Surgical findings: Partial adhesion at Inferior part

12. Case 65M Falx Meningioma Surgical findings: No adhesion
Pre-surgical CE-MRI Brain surface motion image
Surgical findings: No adhesion

13. Case 46F High convexity meningioma Surgical findings: Diffuse adhesion
Pre-surgical CE-MRI Brain surface motion image
Surgical findings: Diffuse adhesion

14. Result: Agreement to surgical findings
Brain surface motion image vs. surgical findings
Surgical findings
Brain motion image Diffuse Partial No
Diffuse 5 1 3
Partial 0 6 1
No 0 0 3
agreed in 66%(14/18)
Peritumoral band on T2WI vs. surgical findings
Surgical findings
Peritumoral band Diffuse Partial No
Diffuse 4 2 3
Partial 1 1 2
No 0 3 2
agreed in 38%(7/18)

15. Result: Partial adhesion
Agreements in location of adhesion between brain surface motion image and surgical findings
Site of Brain motion image Surgical findings
meningioma -Location of -Location of adhesion
band defect
46F Falx Anteromedial part Anteromedial part
67M Parasagittal Diffuse Inferior part
72F Parasagittal Inferior part Inferior part
67F Parasagittal Inferior part Inferior part
65F Parasagittal Posterior part Posterior part
58M Convexity Anterior part Anterior part

16. Discussion
Prediction for brain/meningioma adhesion by brain surface motion imaging agreed with surgical findings in 66% of the cases. While that of peritumorl band agreed in 38% of the cases.
In partial adhesion cases, location of adhesion also made good agreement (5 cases/6 cases).

17. Discussion Problem of patient’s bulk motion:
Patients tend to move between the two acquisition especially at the pause between the two scans.
Leads to misregistration in simple subtraction image.
3D motion correction is needed to overcome the problem by patient’s bulk motion.
3D motion correction needs much time and the results are not sufficient in some cases.
Development of “Single acquisition method”
To suppress patient’s bulk motion
Bind two acquisition into single sequence
No pause between the two scans.

18. Single acquisition method
3D-motion correction was not applied
T2-WI CE-MRI Brain surface motion image
Surgical findings: Partial adhesion at caudal part

19. Single acquisition method
５７F
3D-motion correction was not applied
T2-WI CE-MRI Brain surface motion image
Surgical findings: No adhesion

20. Evaluation of single acquisition method
Comparison with the original (two acquisition) method
Another 10 cases of meningiomas for single acquisition method
Clarity of the band like texture
Clear Moderate Unclear
Misregistration of the cranium by patient’s bulk motion
(After 3D motion correction for the original method)
None Moderate Severe
Agreement to surgical findings

21. Evaluation of single acquisition method
Clarity of the band like texture
Clear Moderate Unclear
Two acq.（n=18）
Single acq.（n=10） 6 4 0
Misregistration of the cranium by patient’s bulk motion
None Moderate Severe
Two acq.（n=18）
Single acq.（n=10）

22. Evaluation of single acquisition method
Agreement with surgical findings
Original (two acquisition) method
Surgical findings
Brain motion image Diffuse Partial No
Diffuse 5 1 3
Partial 0 6 1
No 0 0 3
agreed in 66%(14/18)
Single acquisition method
Surgical findings
Brain motion image Diffuse Partial No
Diffuse 1 0 0
Partial 1 4 1
No 0 0 3
agreed in 80%(8/10)

23. Conclusion
Pulsatile motion of brain surface could be evaluated using brain surface motion images.
Brain surface motion imaging seems to be feasible as providing presurgical information about adhesion between brain surface and meningioma.
Single acquisition method seems to be useful in suppressing patient’s bulk motion and showed good agreement to the surgical findings.