Survival implications of postoperative restricted diffusion in high-grade glioma and limitations of intraoperative MRI detection. J Neurooncol 2024 Nov;170(2):419-428
Date
09/24/2024Pubmed ID
39316313DOI
10.1007/s11060-024-04767-3Scopus ID
2-s2.0-85204800093 (requires institutional sign-in at Scopus site)Abstract
PURPOSE: Here we assess whether the volume of cerebral ischemia induced during glioma surgery may negatively impact survival independently of neurological function. We also evaluate the sensitivity of intraoperative MRI (iMRI) in detecting cerebral ischemia during surgery.
METHODS: We retrospectively reviewed 361 cranial surgeries that used a 3 Tesla iMRI. 165 patients met all inclusion criteria and were included in the final analysis. Diffusion weighted imaging (DWI) obtained during iMRI was compared to postoperative DWI obtained within 7 days of the operation in cases where no further resection occurred after the iMRI.
RESULTS: 42 of 165 patients (25%) showed at least some evidence of restricted diffusion on postoperative (poMRI). 37 of these 42 (88%) cases lacked evidence of restricted diffusion on iMRI, meaning iMRI had a false-negative rate of 88% and a sensitivity of 12% in assessing the extent of ischemic brain after surgery. In high-grade gliomas, the volume of restricted diffusion on poMRI was predictive of overall survival, independent of new functional deficits acquired during surgery (p = 0.011).
CONCLUSION: This study presents the largest case series to date analyzing the sensitivity of iMRI in detecting surgical ischemia. In high-grade gliomas, increased volume of ischemia correlated with worsening median overall survival (OS) irrespective of postoperative neurologic deficits. Future work will focus on improving intraoperative detection of ischemia during the hyperacute phase when interventions such as blood pressure modulation or direct application of vasodilator agents may be effective.
Author List
Aaronson DM, Laing B, Singhal I, Boerger TF, Beck RT, Mueller WM, Krucoff MOAuthors
Ryan T. Beck MD Assistant Professor in the Radiology department at Medical College of WisconsinTimothy F. Boerger LAT Postdoctoral Researcher 3 in the Neurosurgery department at Medical College of Wisconsin
Max O. Krucoff MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
Wade M. Mueller MD Professor in the Neurosurgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Brain Ischemia
Brain Neoplasms
Diffusion Magnetic Resonance Imaging
Female
Glioma
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Monitoring, Intraoperative
Neoplasm Grading
Neurosurgical Procedures
Postoperative Complications
Retrospective Studies
Young Adult