IMPACT OF INTRAOPERATIVE HIGH-FIELD MAGNETIC RESONANCE IMAGING GUIDANCE ON GLIOMA SURGERY: A PROSPECTIVE VOLUMETRIC ANALYSIS
IMPACT OF INTRAOPERATIVE HIGH-FIELD MAGNETIC RESONANCE IMAGING GUIDANCE ON GLIOMA SURGERY: A PROSPECTIVE VOLUMETRIC ANALYSIS
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DOI：
10.1227/01.neu.0000345647.58219.07
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发表时间：
2009-06-01
期刊：
影响因子：
4.8
通讯作者：
Sawaya, Raymond
中科院分区：
文献类型：
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作者：
Hatiboglu, Mustafa Aziz;Weinberg, Jeffrey S.;Sawaya, Raymond
目的：确定术中磁共振成像 (iMRI) 对决定在手术期间进行额外的神经胶质瘤切除术以及最大限度地扩大切除范围 (EOR) 的影响。方法：在 2006 年 9 月至 2007 年 8 月期间对在高场 iMRI 指导下接受开颅手术进行神经胶质瘤切除术的患者进行前瞻性评估。使用 iMRI 评估体积分析和 EOR，使用肿瘤的对比后 T1 加权图像来评估对非增强肿瘤进行增强和 T2 加权图像。结果：46 名患者在 iMRI 指导下接受了切除术，其中 iMRI 用于评估 44 名患者的 EOR，并用于 2 名患者的重新登记。 23 名患者 (52%) 在 iMRI 后终止手术，因为已实现大体完全切除或在大脑功能区残留肿瘤浸润。 21 名患者 (47%) 在 iMRI 后接受了残余肿瘤的额外切除。对于增强型胶质瘤，随着 iMRI 后额外切除肿瘤，中位 EOR 从 84%（范围 59%-97%）显着增加至 99%（范围 85%-100%）（P < 0.001）。对于非增强胶质瘤，iMRI 后额外切除肿瘤后，中位 EOR 增加（从 63% 至 80%），但由于样本量较小（7 名患者），影响并不显着。总体而言，EOR 从 76%（范围 35%-97%）增加到 96%（范围 48%-100%）（P < 0.001）。 21 名患者中有 15 名 (71%) 在 iMRI 后额外切除肿瘤后实现了大体全切除。总体而言，29 名患者 (65%) 经历了总体切除，其中 15 名患者 (52%) 是在 iMRI 的帮助下实现的。结论：高场 iMRI 是一种安全可靠的技术，其使用优化了胶质瘤切除范围。
OBJECTIVE: To determine the impact of intraoperative magnetic resonance imaging (iMRI) on the decision to proceed with additional glioma resection during surgery and to maximize extent of resection (EOR).METHODS: Patients who underwent craniotomy for glioma resection with high-field iMRI guidance were prospectively evaluated between September 2006 and August 2007. Volumetric analysis and EOR were assessed with iMRI, using postcontrast T1-weighted images for tumors showing contrast enhancement and T2-weighted images for nonenhancing tumors.RESULTS: Forty-six patients underwent resection using iMRI guidance, with iMRI being used to evaluate the EOR in 44 patients and for reregistration in 2 patients. Surgery was terminated after iMRI in 23 patients (52%) because gross total resection was achieved or because of residual tumor infiltration in an eloquent brain region. Twenty-one patients (47%) underwent additional resection of residual tumor after iMRI. For enhancing gliomas, the median EOR increased significantly from 84% (range, 59%-97%) to 99% (range, 85%-100%) with additional tumor removal after iMRI (P < 0.001). For nonenhancing gliomas, the median EOR increased (from 63% to 80%) with additional tumor removal after iMRI, but not significantly, owing to the small sample size (7 patients). Overall, the EOR increased from 76% (range, 35%-97%) to 96% (range, 48%-100%) (P < 0.001). Gross total resection was achieved after additional tumor removal after iMRI in 15 of 21 patients (71%). Overall, 29 patients (65%) experienced gross total resection, and in 15 (52%), this was achieved with the contribution of iMRI.CONCLUSION: High-field iMRI is a safe and reliable technique, and its use optimizes the extent of glioma resection.