gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Diffusion tensor imaging in patients with intramedullary tumors – comparison with intraoperative findings and value for prediction of tumor resectability

Meeting Abstract

  • M. Setzer - H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program and Department of Neurosurgery, University of South Florida College of Medicine, Tampa, USA
  • R. Murtagh - H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, University of South Florida, Department of Neuroradiology, College of Medicine, Tampa, Florida, USA
  • F. Murtagh - H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program and Department of Neuroradiology, University of South Florida College of Medicine, Tampa, USA
  • G. Marquardt - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Deutschland
  • V. Seifert - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main, Deutschland
  • F. Vrionis - H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program and Department of Neurosurgery, University of South Florida College of Medicine, Tampa, USA

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP02-02

DOI: 10.3205/09dgnc262, URN: urn:nbn:de:0183-09dgnc2629

Veröffentlicht: 20. Mai 2009

© 2009 Setzer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: The aim of this retrospective study was to evaluate the predictive value of DTI with respect to resectability of intramedullary spinal cord tumors and to determine the concordance of this method with intraoperative surgical findings.

Methods: Study design was retrospective. 13 patients with intramedullary lesions of the spinal cord at different levels (7 male, 6 female; mean age: 51.9 ± 14.8 years) underwent a full tensor diffusion imaging. Patients were classified according to the fiber course with respect to the lesion and rated as resectable vs. non-resectable. These results were compared to the surgical situation (existence vs. absence of cleavage plane) as a “gold-standard”. The inter-rater reliability (kappa coefficient of Cohen) as well as sensitivity, specificity, positive, and negative predictive values were calculated.

Results: Of the 13 patients (7 male, 6 female; mean age: 51.9 ± 14.8 years) 12 had intramedullary tumors (7 ependymomas, 2 lymphomas and 3 astrocytoma, 1 multiple sclerosis plaque). The tumors could be classified in 3 types according to the fiber course: Type 1: fibers do not enter the solid lesion; Type II: some fibers cross the lesion, but most of the lesion volume does not contain fibers; Type III: most of the tumor volume does contain fibers. Based on these results 6 lesions were considered as resectable, 7 were not. During surgery 7 tumors showed a good cleavage plane, 6 did not. The inter-rater reliability (Cohen’s kappa) between DTI evaluation concerning the resectability of intramedullary tumors and the intraoperative surgical findings was calculated to 0.833 (p<0.003) which is considered as substantial agreement according to the criteria of Landis and Koch. The sensitivity for DTI to predict a possible tumor resection with respect to the gold standard intraoperative aspect was 85.7%, the specificity was 100%, the positive predictive value 100% and the negative predictive value 83.3%. Because of the patient number confidence intervals could not be calculated.

Conclusions: These preliminary data suggest that DTI in patients with spinal cord tumors is capable of predicting the resectability of the lesion. A further prospective study is needed to confirm these results and if they have an impact on patient outcome.