2011.06.08, ck image talk
TRANSCRIPT
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IMAGING FOR CYBERKNIFE
Steven D. Chang, MDProfessor of NeurosurgeryCo-Director Stanford CyberKnife Center
Robert Lieberson, MDAssistant Professor of Neurosurgery
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CyberKnife imaging protocols
Brain Glioma or Metastasis or Resection Cavity or Meningioma
Cover from vertex to baseAX T1, W GAD, 2 mm cuts / skip 0
Acoustic Neuromacover from orbit to baseAx T1, w GAD, 2 mm /0 mmAx 2D Fiesta, 1.5 mm /0 mm
Trigeminal Neuralgia3-Tesla, center at sellaAx 2D Fiesta, 1.5 mm/ 0 mm
Pituitary TumorCover top of orbit to baseAx T1 with gad and fat sat, 2 mmCover back of ear to tip of nose Cor T1, with gad and fat satOption: Ax 2D Fiesta, 2 mm
Skull Base Tumor/NPCCover top of orbit to baseAx T1, pre 2 mm/0 mm Ax T1, post and fat sat, 2 mm/0 Cover back of ear to tip of noseCor T1, post and fat sat, 2 mm
Nasopharyngeal CarcinomaCover from soft palate to vertexAx T1, pre, 2 mm/0 mm Ax T1, post-gad and fat satCover back of ear to tip of noseCor T1, post and fat sat, 2 mm
AVMCover from vertex to baseAx T2 pre 2 mm/0 mm Axl T1, post 2 mm/0 mm
Orbital Tumor Cover from vertex to baseAx T1, pre with fat sat 2 mm Ax T1, post and fat sat, 2 mmAxial T2 2mm/0 mm Cor T1, post and fat sat 2 mm
Paraganglioma/Glomus Tumor Cover from top of orbit to C7Ax T1, post, 2 mm/0 mmT2, 2 mm/0 mm
SpineC1 or C2
Tumor (NO instrumentation)Cover from orbits to C3 3 PL SSFSE loc Ax 2D FIESTA, 3 mm /0 mmAx T1 FSE XL, post fat sat
Tumor, (WITH instrumentation)Cover from orbits to C3 3 PL SSFSE locAx 2D FIESTA, 3 mmAx T1 IDEAL, post, 2 mm
C3 or Below Tumor (NO instrumentation)
Cover 2 lvls above, below3 PL SSFSE loc Ax 2D FIESTA, 3mm/0 mmAx T1 FSE XL, post fat sat, 3 mm/0 mm, 22 cm FOV
Tumor (WITH instrumentation)Cover 2 levels above, below
3 PL SSFSE locAx 2D FIESTA, 3 mm/0 mmAxial T1 IDEAL, post, 3 mm
AVM C1 C2Cover from orbits to C33 PL SSFSE locAx T2, FSE, 2 mm/0 mmAx 2D Fiesta, 2 mm/0 mm
Below C3Cover 2 levels above, below3 PL SSFSE locAx 2D FIESTA, 3 mm/0 mmAx T2, FSE, 3 mm/0 mm
Brachial PlexusAx T1, pre Ax T1, post-gad with fat satCor T1, post-gad with fat sat
PelvisAxial T1-weighted, preAxial T1-weighted, post
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R Parietal AVM
Contrast CT
Limited by artifact
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R Parietal AVM
3-D Angiogram Subtracted
Less artifact
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R Parietal AVM
Contrast CT plus 3-D angiogram
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Contrast CT
AVM not easily separated from feeders
C2 AVM
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C2 AVM
3-D Angiogram
Feeders visible
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Fiesta MRI
Cord contour well seen
C2 AVM
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Contrast CT
Bony destruction well seen
Spine Met
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Contrast T1 MRI scan
The area of tumor invasion is much larger
Spine Met
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Contrast CT
Lesion not visible
T8 SCIM(Ependymoma
)
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Contrast T1 MRI
Lesion well seen
T8 SCIM(Ependymoma
)
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Fiesta MRI
Confusing appearance
T8 SCIM(Ependymoma
)
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T8 SCIM(Ependymoma
)
CT plus T1 MRI
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Contrast T1 MRI
Extent of tumor in IAC not clear
Acoustic Neuroma
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Fiesta MRI
The tumor does not extend to the lateral end of the IAC
Acoustic Neuroma
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Acoustic Neuroma
Contrast CT
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Trigeminal Neuralgia
Contrast CT with contours
Wide view for orientation
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Trigeminal Neuralgia
Contrast CT with contours
Magnified
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Trigeminal Neuralgia
Fiesta MRI with contours
Blue is previously placed Teflon pad
Pink is target in CN. V
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Thank You