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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Perfusion-weighted imaging in the intraoperative MR suite: feasibility and influence on maximisation of the tumour resection

Meeting Abstract

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  • Sotirios Bisdas - Diagnostic and Interventional Neuroradiology, Department of Radiology
  • Constantin Roder - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
  • Rainer Ritz - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
  • Jürgen Honegger - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
  • Thomas Naegele - Diagnostic and Interventional Neuroradiology, Department of Radiology
  • Ulrike Ernemann - Diagnostic and Interventional Neuroradiology, Department of Radiology
  • Marcos S. Tatagiba - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.14.02

doi: 10.3205/13dgnc118, urn:nbn:de:0183-13dgnc1182

Published: May 21, 2013

© 2013 Bisdas et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: To examine the feasibility of routine perfusion-weighted intraoperative MR imaging (iMRI) and to evaluate its usefulness as an aid to detect the residual tumor and and maximise the tumour resection extent.

Method: Twenty-eight patients underwent perfusion-weighted iMRI (in a dual-room 1.5-T magnet setting) after contrast agent administration in order to evaluate the resection of high-grade gliomas. The generated relative cerebral blood volume (rCBV) maps were superimposed in the diagnostic T1-weighted images and were scrutinised for any hyper-perfused regions, indicative of tumour remnants. A hand-drawn region-of-interest (ROI) analysis was performed in order to detect differences between the rCBV values in suspected residual tumour, free tumour margins and normal white matter. Using neuronavigation, tissue specimens from the suspected areas were sampled and referred to histopathology.

Results: Artefact-free rCBV perfusion maps were generated in all cases. The lack of any hyper-perfused areas was consistent with macroscopically as well as histopathologically verified gross total resection of gliomas in 7 cases. However, in 21 cases, the perfusion-weighted iMRI revealed "hot-spots" indicating hyper-perfused tumour residuums after subtotal tumour removal. The latter proved to be histologically true in all but one case. Therefore, the diagnostic performance of the qualitative visual and the quantitative analysis showed excellent sensitivity and specificity rates. Statistically significant differences for mean rCBV and maximum rCBV were demonstrated between residual tumour and tumour free surgical margins, (P = .0017) and (P = .0021) respectively.

Conclusions: The perfusion-weighted imaging is feasible in the intraoperative MR suite and can be easily implemented in the routine MRI protocols. The perfusion iMRI findings may assist the surgeon in detecting residual tumor volume and achieving a total tumour resection.