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Real-time ultrasound-MRI fusion image virtual navigation for locating intraspinal tumour in a pregnant woman

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Abstract

Background

Standard fluoroscopic guidance (C-arm fluoroscopy) has been routinely used for intraoperative localization of spinal level for surgical removal of intraspinal tumour, while it is not suitable for selected patients, e.g. pregnant women, who need to avoid radiation exposure. Fusion imaging of real-time ultrasound (US) and magnetic resonance imaging (MRI) is a radiation-free technique which has been reported to have good localization accuracy in managing several conditions.

Clinical presentation

A 37-year-old pregnant patient, presented with a progressively aggravating lower back pain for 20 days and was incapable of lying supine with lower extremities swelling for 1 week, was referred to our hospital in her 18th week of gestation. Lumbar MRI identified an L1 level intraspinal lesion, and surgery was planned. To avoid the ionizing radiation generated by fluoroscopy, volume navigation technique (VNT) based fusion imaging of US and MRI was used to localize the intraspinal lesion, which was removed entirely via minimally invasive interlaminar approach. Pathological examination confirmed the diagnosis of ependymoma of the conus medullaris. Her symptoms were largely relieved after the operation, and a healthy baby was delivered at the 40th week of pregnancy.

Conclusion

We presented the first case of using VNT based fusion imaging of real-time US/MRI to guide the surgical resection of an intraspinal tumour. Future study with larger patient number is needed to validate this technique as an alternative to fluoroscopy in patients who need to avoid radiation exposure.

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Acknowledgements

We would like to thank Dr. Lin-Guo Lu, clinical applications specialist from Esaote S.p.A., for his support in preforming fusion imaging and help in writing the technical part of fusion imaging.

Funding

This study was supported by Science and Technology Department of Zhejiang Province (Grant no. 2007C33042) and Provincial Key R&D Program, Science and Technology Department of Zhejiang Province (Grant no. 2017C03018).

Author information

Author notes

  1. Tian-Jian Liu and Fang Shen contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China

    Tian-Jian Liu & Yong-Jian Zhu

  2. Ultrasound Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China

    Chao Zhang & Pin-Tong Huang

  3. Department of Orthopaedic Surgery’s Spine Division, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China

    Fang Shen

Authors
  1. Tian-Jian Liu
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  2. Fang Shen
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  3. Chao Zhang
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  4. Pin-Tong Huang
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  5. Yong-Jian Zhu
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Contributions

TJL and FS conceived and wrote the manuscript. CZ and PTH did data collection and contributed to manuscript writing. YJZ did the review and final approval of the manuscript.

Corresponding author

Correspondence to Yong-Jian Zhu.

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Ethical statement

The patient has given her informed consent to the publication of her data. Ethical approval was obtained from the Ethics Committee of Second Affiliated Hospital of Zhejiang University School of Medicine.

Conflict of interest

The authors declare that they have no conflict of interest.

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Liu, TJ., Shen, F., Zhang, C. et al. Real-time ultrasound-MRI fusion image virtual navigation for locating intraspinal tumour in a pregnant woman. Eur Spine J 27 (Suppl 3), 436–439 (2018). https://doi.org/10.1007/s00586-017-5442-7

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  • DOI: https://doi.org/10.1007/s00586-017-5442-7

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