To define regions of interest (ROI), manual tumour segmentation was performed using contrast-enhanced T1-weighted sequences or T2-weighted/FLAIR images (3 Tesla MRI data) and the StealthViz neurosurgical planning software (Version 1.2, Medtronic, Louisville, CO, USA). Referring to the Response Assessment in Neuro-Oncology (RANO) criteria, the extension of the glioma was defined by the contrast-enhancing area on T1-weighted MR images in suspected HGG with significant CE and by the non-enhancing hyperintense lesion on T2-weighted/FLAIR sequences in suspected LGG with no significant CE [40 (link)]. As LIV values describe the image heterogeneity in neighbouring voxels, care was taken not to include LIV values derived from heterogeneities caused by other sources than pathological intratumoral alterations such as the brain surface, neighbouring blood vessels or the ventricles. In such cases the initially segmented tumour ROI was adjusted to exclude such confounding values.
Stealthviz
Manufactured by Medtronic
Sourced in United States
StealthViz is a medical imaging software product developed by Medtronic. It is designed to assist healthcare professionals in visualizing and analyzing medical images, such as those from CT scans or MRI scans. The core function of StealthViz is to provide advanced image processing and visualization capabilities to aid in medical diagnosis and treatment planning.
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Lab products found in correlation
5 protocols using stealthviz
1
MRI-Based Glioma Segmentation and Heterogeneity Assessment
2
Structural Connectivity of Prefrontal Cortex
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All measurements of FAT were performed, refined and depicted using StealthViz neuronavigation software (Medtronic Inc., Minneapolis, USA) with the StealthDTI module. Using the option of segmentation, the regions of interest (SMA and pre-SMA, pars opercularis of the IFG [IFG-Op], pars triangularis of the IFG [IFG-Tr] and pars orbitalis of the IFG) were identified and manually marked (Fig. 1).
Then, the ipsilateral neural bundles between particular parts of SFG and IFG were automatically plotted by the software. Seed density was set at 2.0, the maximal directional change at 50 degrees, and the minimal fibre length at 1 mm. All DTI tracking settings were consistent throughout the MRIs. Lateralisation index was calculated by the established formula [4, (link)14] (link).
The anatomical variability of IFG-Tr was evaluated in T1/T2-weighed MRI. Depending on the configuration of the Sylvian fissure, the IFG-Tr can form a V-shape (two rami spread from one point right above the Sylvian fissure that forms the apex of the triangle), a U-shape (mentioned rami spread from one point like in V-shape, but further apart), a Y-shape (rami spread from common stem) and a J-shape (an asymmetry in length of two rami) (Fig. 2) [7] .
Then, the ipsilateral neural bundles between particular parts of SFG and IFG were automatically plotted by the software. Seed density was set at 2.0, the maximal directional change at 50 degrees, and the minimal fibre length at 1 mm. All DTI tracking settings were consistent throughout the MRIs. Lateralisation index was calculated by the established formula [4, (link)14] (link).
The anatomical variability of IFG-Tr was evaluated in T1/T2-weighed MRI. Depending on the configuration of the Sylvian fissure, the IFG-Tr can form a V-shape (two rami spread from one point right above the Sylvian fissure that forms the apex of the triangle), a U-shape (mentioned rami spread from one point like in V-shape, but further apart), a Y-shape (rami spread from common stem) and a J-shape (an asymmetry in length of two rami) (Fig. 2) [7] .
3
High-Directional DTI for Stereotactic Radiosurgery
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High-directional DTI was performed at the time of standard GKRS protocol MRI (T1 and T2 weighted) for treatment, with the patient's head secured by a Leksell stereotactic frame and our standard "birdcage" transmit/ receive head coil.
We used a high-directional resolution DTI sequence single-shot spin echo-echo planar sequence (TR 2700 msec, TE 160 msec), acquiring 60-68 interleaved, contiguous 2-mm-thick axial images with no cardiac triggering.
A data matrix of 512 × 345 pixels over an FOV of 210 × 210 mm was obtained. Diffusion gradients were applied in 32 noncollinear independent axes by using a b value of 0 and 1000 sec/mm 2 . Each complete DTI data set required an additional 14-16 minutes of MR scanning time. The DTI and the T1-and T2-weighted data sets were transferred via CD to a StealthViz (Medtronic, Inc.) workstation for postprocessing.
We used a high-directional resolution DTI sequence single-shot spin echo-echo planar sequence (TR 2700 msec, TE 160 msec), acquiring 60-68 interleaved, contiguous 2-mm-thick axial images with no cardiac triggering.
A data matrix of 512 × 345 pixels over an FOV of 210 × 210 mm was obtained. Diffusion gradients were applied in 32 noncollinear independent axes by using a b value of 0 and 1000 sec/mm 2 . Each complete DTI data set required an additional 14-16 minutes of MR scanning time. The DTI and the T1-and T2-weighted data sets were transferred via CD to a StealthViz (Medtronic, Inc.) workstation for postprocessing.
4
Diffusion Tensor Tractography of Supplementary Motor and Premotor Cortex
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Diffusion tensor imaging tractography analysis using DTI data was performed with a surgical navigation system (StealthStation S7, Medtronic). Standard deterministic streamline DTT was performed with StealthViz software (Medtronic) using a fractional anisotropy threshold of 0.2 and a DTI maximum turning angle of 100°. Using DTT fiber data, we assessed the number of fibers between two distal seed regions of interest (ROIs) that started from the contralateral SMA and projected to the ipsilateral PMC via the corpus callosum. These ROIs were identified on MRI using the method described by Berger et al. 3 All streamlines passing through the ROIs were retained. No additional tract editing was performed. As DTT analysis involves tracking the voxels of water diffusion signal, we defined these voxel numbers as NFidx (number of fiber tracts) and counted the number of target fibers. 9
5
Diffusion Tensor Imaging Protocol
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A DTI sequence was obtained using the following technical MRI data: TR 8000 msec, TE 83 msec, FOV 256, matrix size 128 × 128, diffusion directions 30, b-values 0 and 800 sec/mm, slice thickness 2 mm, 65 slices, acquisition time 4.34 minutes. For postprocessing of DTI data, we applied the commercially available StealthViz software (Medtronic) that is part of the planning station. This software was used for visualization of the corticospinal tract and the arcuate fascicle. For this purpose, the corticospinal tract was created manually by selecting 2 regions of interest (ROIs) within the cerebral peduncle and the precentral gyrus as defined by anatomical or functional MRI (fMRI) data. For the arcuate fascicle the ROIs were placed within Broca's and Wernicke's area and/or according to the fMRI data.
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