Multimodal imaging for improved diagnosis and treatment of cancers

Abstract

The authors review methods for image-guided diagnosis and therapy that increase precision in the detection, characterization, and localization of many forms of cancer to achieve optimal target definition and complete resection or ablation. A new model of translational, clinical, image-guided therapy research is presented, and the Advanced Multimodality Image-Guided Operating (AMIGO) suite is described. AMIGO was conceived and designed to allow for the full integration of imaging in cancer diagnosis and treatment. Examples are drawn from over 500 procedures performed on brain, neck, spine, thorax (breast, lung), and pelvis (prostate and gynecologic) areas and are used to describe how they address some of the many challenges of treating brain, prostate, and lung tumors. Cancer 2015;121:817-827. © 2014 American Cancer Society.

Keywords: brain tumor; interventional magnetic resonance imaging; intraoperative monitoring; lung cancer; mass spectroscopy; multimodal imaging; neuroimaging; neuronavigation; prostate biopsy; prostate cancer.

Figure 1

Overview of the AMIGO suite showing the layout of the CT, Operating and MRI rooms.

Figure 2

Operating room with access to the 3T MRI, interventional C-arm CT, and additional navigation devices.

Figure 3

Preoperative planning images for image-guided neurosurgery.

Figure 4

Neurosurgical intraoperative images showing microscopic view of the target and surrounding structures.

Figure 5

(a) Diagnostic MRI showing extent of tumor (b) Intraprocedural MRI prior to resection of the tumor (c) Post-procedural MRI confirming the complete tumor resection.

Figure 6

(a) Axial T2W image showing a normal prostate gland (b) Coronal T2W image of the same patient.

Figure 7

mpMRI of patient's prostate cancer (a) T2W (b) DWI (c) ADC (d) Subtracted (e) K^trans (f) v_e images. Red arrow indicates the tumor. ADC of 682 for an ROI within the tumor.

Figure 8

(a) T2W imaging showing needle artifact (black dot) within tumor (b) DWI image confirming needle position (c) Reformatted T2W Coronal image (d) Reformatted DWI coronal image.

Figure 9

MRI used for monitoring the progression of the iceball during cryotherapy. (a) Pre-treatment (b) 2 mins (c) 4 mins (d) 10 mins (e) 15 mins after the start of cryotherapy.

Figure 10

3D Slicer-based planning and monitoring for cryotherapy. 3D models of iceball and tumor show complete eclipsing of the tumor by iceball, ensuring adequate tumor treatment.