title: First intraoperative, shared-resource, ultrahigh-field 3-Tesla magnetic resonance imaging system and its application in low-grade glioma resection.
abstract: OBJECTIVE
  The authors describe the first shared-resource, 3-T intraoperative MR (ioMR) imaging system and analyze its impact on low-grade glioma (LGG) resection with an emphasis on the use of intraoperative proton MR spectroscopy.
  
  
  METHODS
  The Acibadem University ioMR imaging facility houses a 3-T Siemens Trio system and consists of interconnected but independent MR imaging and surgical suites. Neurosurgery is performed using regular ferromagnetic equipment, and a patient can be transferred to the ioMR imaging system within 1.5 minutes by using a floating table. The ioMR imaging protocol takes < 10 minutes including the transfer, and the authors obtain very high-resolution T2-weighted MR images without the use of intravenous contrast. Functional sequences are performed when needed. A new 5-pin headrest-head coil combination and floating transfer table were specifically designed for this system.
  
  
  RESULTS
  Since the facility became operational in June 2004, 56 LGG resections have been performed using ioMR imaging, and > 19,000 outpatient MR imaging procedures have been conducted. First-look MR imaging studies led to further resection attempts in 37.5% of cases as well as a 32.3% increase in the number of gross-total resections. Intraoperative ultrasonography detected 16% of the tumor remnants. Intraoperative proton MR spectroscopy and diffusion weighted MR imaging were used to differentiate residual tumor tissue from peritumoral parenchymal changes. Functional and diffusion tensor MR imaging sequences were used both pre- and postoperatively but not intraoperatively. No infections or other procedure-related complications were encountered.
  
  
  CONCLUSIONS
  This novel, shared-resource, ultrahigh-field, 3-T ioMR imaging system is a cost-effective means of affording a highly capable ioMR imaging system and increases the efficiency of LGG resections.
authors.affiliation: Department of Neurosurgery, Acibadem University, School of Medicine, Istanbul, Turkey.
authors.forename: M Necmettin
authors.initials: MN
authors.lastname: Pamir
authors.forename: Koray
authors.initials: K
authors.lastname: Ozduman
authors.forename: Alp
authors.initials: A
authors.lastname: Dinçer
authors.forename: Erdem
authors.initials: E
authors.lastname: Yildiz
authors.forename: Selçuk
authors.initials: S
authors.lastname: Peker
authors.forename: M Memet
authors.initials: MM
authors.lastname: Ozek
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging / Q000191:economics / Q000379:methods; D005160:Facility Design and Construction / Q000191:economics; D005260:Female; D005910:Glioma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D009367:Neoplasm Staging; D019635:Neurosurgical Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D014463:Ultrasonography / Q000191:economics / Q000379:methods; D055815:Young Adult