Use of High-Field Intraoperative Magnetic Resonance Imaging to Enhance the Extent of Resection of Enhancing and Nonenhancing Gliomas
Use of High-Field Intraoperative Magnetic Resonance Imaging to Enhance the Extent of Resection of Enhancing and Nonenhancing Gliomas
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DOI：
10.1227/neu.0000000000000278
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发表时间：
2014-04-01
期刊：
影响因子：
4.8
通讯作者：
Vogelbaum, Michael A.
中科院分区：
文献类型：
--
作者：
Mohammadi, Alireza Mohammad;Sullivan, T. Barrett;Vogelbaum, Michael A.
背景：术中磁共振成像（IoMRI）用于改善脑肿瘤的切除范围。大多数以前的研究评估效用的IoMRI集中在增强tumors.Objective：报告我们的经验与使用高场IoMRI（1.5 T）的增强和nonenhancing gliomas.METHODS：机构审查委员会批准的回顾性审查进行了102个连续的胶质瘤患者（104手术，2010-2012）。评估术前、术中和术后肿瘤体积。分析进行了使用体积T2图像在43个nonenhancing和13个最低限度地提高肿瘤和对比后体积磁化准备的快速梯度回波图像在48个增强tumors.Results：在58例，术前成像显示肿瘤可能是适合完全切除。32例手术中进行了术中皮质电描记术，14例由于累及深部功能结构而导致预期的肿瘤次全切除。25例手术无需进一步切除（IoMRI前完全切除），IoMRI显示79例患者有残留肿瘤。其中，25例手术未进行进一步切除（9例由于皮质电图结果，14例由于深部功能区肿瘤，2例由于外科医生选择）。在54例患者中进行的额外切除导致最终中位残留肿瘤体积为0.21 mL（0.6%）。在79例适合完全切除的患者中，T2组的术中残留肿瘤体积中位数高于磁化准备的快速梯度回波组（1.088 mL vs 0.437 mL; P = 0.049），而术后中位残留肿瘤体积在组间无统计学显著差异。IoMRI增强了切除范围，特别是对于非增强胶质瘤。
BACKGROUND: Intraoperative magnetic resonance imaging (IoMRI) is used to improve the extent of resection of brain tumors. Most previous studies evaluating the utility of IoMRI have focused on enhancing tumors.OBJECTIVE: To report our experience with the use of high-field IoMRI (1.5 T) for both enhancing and nonenhancing gliomas.METHODS: An institutional review board-approved retrospective review was performed of 102 consecutive glioma patients (104 surgeries, 2010-2012). Pre-, intra-, and postoperative tumor volumes were assessed. Analysis was performed with the use of volumetric T2 images in 43 nonenhancing and 13 minimally enhancing tumors and with postcontrast volumetric magnetization-prepared rapid gradient-echo images in 48 enhancing tumors.RESULTS: In 58 cases, preoperative imaging showed tumors likely to be amenable to complete resection. Intraoperative electrocorticography was performed in 32 surgeries, and 14 cases resulted in intended subtotal resection of tumors due to involvement of deep functional structures. No further resection (complete resection before IoMRI) was required in 25 surgeries, and IoMRI showed residual tumor in 79 patients. Of these, 25 surgeries did not proceed to further resection (9 due to electrocorticography findings, 14 due to tumor in deep functional areas, and 2 due to surgeon choice). Additional resection that was performed in 54 patients resulted in a final median residual tumor volume of 0.21 mL (0.6%). In 79 patients amenable to complete resection, the intra-operative median residual tumor volume for the T2 group was higher than for the magnetization-prepared rapid gradient-echo group (1.088 mL vs 0.437 mL; P = .049), whereas the postoperative median residual tumor volume was not statistically significantly different between groups.CONCLUSION: IoMRI enhances the extent of resection, particularly for nonenhancing gliomas.