IMAGING FOR CYBERKNIFE

Steven D. Chang, MDProfessor of NeurosurgeryCo-Director Stanford CyberKnife Center

Robert Lieberson, MDAssistant Professor of Neurosurgery

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

R Parietal AVM

Contrast CT

Limited by artifact

R Parietal AVM

3-D Angiogram Subtracted

Less artifact

R Parietal AVM

Contrast CT plus 3-D angiogram

Contrast CT

AVM not easily separated from feeders

C2 AVM

C2 AVM

3-D Angiogram

Feeders visible

Fiesta MRI

Cord contour well seen

C2 AVM

Contrast CT

Bony destruction well seen

Spine Met

Contrast T1 MRI scan

The area of tumor invasion is much larger

Spine Met

Contrast CT

Lesion not visible

T8 SCIM(Ependymoma

)

Contrast T1 MRI

Lesion well seen

T8 SCIM(Ependymoma

)

Fiesta MRI

Confusing appearance

T8 SCIM(Ependymoma

)

T8 SCIM(Ependymoma

)

CT plus T1 MRI

Contrast T1 MRI

Extent of tumor in IAC not clear

Acoustic Neuroma

Fiesta MRI

The tumor does not extend to the lateral end of the IAC

Acoustic Neuroma

Acoustic Neuroma

Contrast CT

Trigeminal Neuralgia

Contrast CT with contours

Wide view for orientation

Trigeminal Neuralgia

Contrast CT with contours

Magnified

Trigeminal Neuralgia

Fiesta MRI with contours

Blue is previously placed Teflon pad

Pink is target in CN. V

Thank You