The value of intraoperative MRI in recurrent intracranial tumor surgery

View More View Less
  • 1 Department of Neurosurgery, Eberhard Karls University Tübingen, Germany;
  • 2 Institute of Intensive Care Medicine, University Hospital Zurich;
  • 3 Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich;
  • 4 Department of Neuroradiology, University Hospital Zurich, Clinical Neuroscience Center, Zurich; and
  • 5 Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Switzerland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Identifying tumor remnants in previously operated tumor lesions remains a challenge. Intraoperative MRI (ioMRI) helps the neurosurgeon to reorient and update image guidance during surgery. The purpose of this study was to analyze whether ioMRI is more efficient in detecting tumor remnants in the surgery of recurrent lesions compared with primary surgery.

METHODS

All consecutive patients undergoing elective intracranial tumor surgery between 2013 and 2018 at the authors’ institution were included in this retrospective cohort study. The cohort was divided into two groups: re-craniotomy and primary craniotomy. In contrast-enhancing tumors, tumor suspicion in ioMRI was defined as contrast enhancement in T1-weighted imaging. In non–contrast-enhancing tumors, tumor suspicion was defined as hypointensity in T1-weighted imaging and hyperintensity in T2-weighted imaging and FLAIR. In cases in which the ioMRI tumor suspicion was a false positive and not confirmed during in situ inspection by the neurosurgeon, the signal was defined as a tumor-imitating ioMRI signal (TIM). Descriptive statistics were performed.

RESULTS

A total of 214 tumor surgeries met the inclusion criteria. The re-craniotomy group included 89 surgeries, and the primary craniotomy group included 123 surgeries. Initial complete resection after ioMRI was less frequent in the re-craniotomy group than in the primary craniotomy group, but this was not a statistically significant difference. Radiological suspicion of tumor remnants in ioMRI was present in 78% of re-craniotomy surgeries and 69% of primary craniotomy surgeries. The incidence of false-positive TIMs was significantly higher in the re-craniotomy group (n = 11, 12%) compared with the primary craniotomy group (n = 5, 4%; p = 0.015), and in contrast-enhancing tumors was related to hemorrhages in situ (n = 9).

CONCLUSIONS

A history of previous surgery in contrast-enhancing tumors made correct identification of tumor remnants in ioMRI more difficult, with a higher rate of false-positive ioMRI signals in the re-craniotomy group. The majority of TIMs were associated with the inability to distinguish contrast enhancement from hyperacute hemorrhage. The addition of a specific sequence in ioMRI to further differentiate both should be investigated in future studies.

ABBREVIATIONS 5-ALA = 5-aminolevulinic acid; DWI = diffusion-weighted imaging; EOR = extent of resection; GTR = gross-total resection; ioMRI = intraoperative MRI; ioNM = intraoperative neuromonitoring; ioUS = intraoperative ultrasound; SWI = susceptibility weighted imaging; TIM = tumor-imitating ioMRI signal.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Sophie S. Wang: Eberhard Karls University Tübingen, Germany. sophie.wang@med.uni-tuebingen.de.

INCLUDE WHEN CITING Published online October 2, 2020; DOI: 10.3171/2020.6.JNS20982.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Bloch O, Han SJ, Cha S, Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg. 2012;117(6):10321038.

    • Search Google Scholar
    • Export Citation
  • 2

    Lacroix M, Abi-Said D, Fourney DR, A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95(2):190198.

    • Search Google Scholar
    • Export Citation
  • 3

    Scherer M, Ahmeti H, Roder C, Surgery for diffuse WHO grade II gliomas: volumetric analysis of a multicenter retrospective cohort from the German Study Group for Intraoperative Magnetic Resonance Imaging. Neurosurgery. 2020;86(1):E64E74.

    • Search Google Scholar
    • Export Citation
  • 4

    Schneider JP, Trantakis C, Rubach M, Intraoperative MRI to guide the resection of primary supratentorial glioblastoma multiforme—a quantitative radiological analysis. Neuroradiology. 2005;47(7):489500.

    • Search Google Scholar
    • Export Citation
  • 5

    Suchorska B, Weller M, Tabatabai G, Complete resection of contrast-enhancing tumor volume is associated with improved survival in recurrent glioblastoma—results from the DIRECTOR trial. Neuro Oncol. 2016;18(4):549556.

    • Search Google Scholar
    • Export Citation
  • 6

    Kubben PL, ter Meulen KJ, Schijns OE, Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review. Lancet Oncol. 2011;12(11):10621070.

    • Search Google Scholar
    • Export Citation
  • 7

    Nimsky C, Ganslandt O, Cerny S, Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging. Neurosurgery. 2000;47(5):10701080.

    • Search Google Scholar
    • Export Citation
  • 8

    Nabavi A, Black PM, Gering DT, Serial intraoperative magnetic resonance imaging of brain shift. Neurosurgery. 2001;48(4):787798.

  • 9

    Wirtz CR, Knauth M, Staubert A, Clinical evaluation and follow-up results for intraoperative magnetic resonance imaging in neurosurgery. Neurosurgery. 2000;46(5):11121122.

    • Search Google Scholar
    • Export Citation
  • 10

    Senft C, Bink A, Franz K, Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol. 2011;12(11):9971003.

    • Search Google Scholar
    • Export Citation
  • 11

    Claus EB, Horlacher A, Hsu L, Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer. 2005;103(6):12271233.

    • Search Google Scholar
    • Export Citation
  • 12

    Nabavi A, Thurm H, Zountsas B, Five-aminolevulinic acid for fluorescence-guided resection of recurrent malignant gliomas: a phase II study. Neurosurgery. 2009;65(6):10701077.

    • Search Google Scholar
    • Export Citation
  • 13

    Hammoud MA, Ligon BL, elSouki R, Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging. J Neurosurg. 1996;84(5):737741.

    • Search Google Scholar
    • Export Citation
  • 14

    Dinevski N, Sarnthein J, Vasella F, Postoperative neurosurgical infection rates after shared-resource intraoperative magnetic resonance imaging: a single-center experience with 195 cases. World Neurosurg. 2017;103:275282.

    • Search Google Scholar
    • Export Citation
  • 15

    Bohinski RJ, Kokkino AK, Warnick RE, Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection. Neurosurgery. 2001;48(4):731744.

    • Search Google Scholar
    • Export Citation
  • 16

    Reifenberger G, Wirsching HG, Knobbe-Thomsen CB, Weller M. Advances in the molecular genetics of gliomas—implications for classification and therapy. Nat Rev Clin Oncol. 2017;14(7):434452.

    • Search Google Scholar
    • Export Citation
  • 17

    Nimsky C, Ganslandt O, Von Keller B, Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients. Radiology. 2004;233(1):6778.

    • Search Google Scholar
    • Export Citation
  • 18

    Hatiboglu MA, Weinberg JS, Suki D, Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery: a prospective volumetric analysis. Neurosurgery. 2009;64(6):10731081.

    • Search Google Scholar
    • Export Citation
  • 19

    Kuhnt D, Becker A, Ganslandt O, Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance. Neuro Oncol. 2011;13(12):13391348.

    • Search Google Scholar
    • Export Citation
  • 20

    Coburger J, Engelke J, Scheuerle A, Tumor detection with 5-aminolevulinic acid fluorescence and Gd-DTPA-enhanced intraoperative MRI at the border of contrast-enhancing lesions: a prospective study based on histopathological assessment. Neurosurg Focus. 2014;36(2):E3.

    • Search Google Scholar
    • Export Citation
  • 21

    Coburger J, Merkel A, Scherer M, Low-grade glioma surgery in intraoperative magnetic resonance imaging: results of a multicenter retrospective assessment of the German Study Group for Intraoperative Magnetic Resonance Imaging. Neurosurgery. 2016;78(6):775786.

    • Search Google Scholar
    • Export Citation
  • 22

    Quick-Weller J, Lescher S, Forster MT, Combination of 5-ALA and iMRI in re-resection of recurrent glioblastoma. Br J Neurosurg. 2016;30(3):313317.

    • Search Google Scholar
    • Export Citation
  • 23

    Gustafsson O, Rossitti S, Ericsson A, Raininko R. MR imaging of experimentally induced intracranial hemorrhage in rabbits during the first 6 hours. Acta Radiol. 1999;40(4):360368.

    • Search Google Scholar
    • Export Citation
  • 24

    Halefoglu AM, Yousem DM. Susceptibility weighted imaging: clinical applications and future directions. World J Radiol. 2018;10(4):3045.

    • Search Google Scholar
    • Export Citation
  • 25

    Rohde V, Rohde I, Thiex R, The role of intraoperative magnetic resonance imaging for the detection of hemorrhagic complications during surgery for intracerebral lesions an experimental approach. Surg Neurol. 2001;56(4):266275.

    • Search Google Scholar
    • Export Citation
  • 26

    Giordano M, Samii A, Lawson McLean AC, Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility. J Neurosurg Pediatr. 2017;19(1):7784.

    • Search Google Scholar
    • Export Citation
  • 27

    Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol. 1990;8(7):12771280.

    • Search Google Scholar
    • Export Citation
  • 28

    Vogelbaum MA, Jost S, Aghi MK, Application of novel response/progression measures for surgically delivered therapies for gliomas: Response Assessment in Neuro-Oncology (RANO) Working Group. Neurosurgery. 2012;70(1):234244.

    • Search Google Scholar
    • Export Citation
  • 29

    van den Bent MJ, Vogelbaum MA, Wen PY, End point assessment in gliomas: novel treatments limit usefulness of classical Macdonald’s criteria. J Clin Oncol. 2009;27(18):29052908.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 294 294 294
Full Text Views 27 27 27
PDF Downloads 14 14 14
EPUB Downloads 0 0 0