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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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High-grade intracranial gliomas exhibit wide-spread impaired cerebrovascular reactivity

Meeting Abstract

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  • Jorn Fierstra - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
  • Bas van Niftrik - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
  • Marco Piccirelli - Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
  • Jan Karl Burkhardt - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
  • Luca Regli - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
  • Oliver Bozinov - Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 025

doi: 10.3205/16dgnc400, urn:nbn:de:0183-16dgnc4005

Published: June 8, 2016

© 2016 Fierstra et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: In pre-surgical planning of intracranial high-grade gliomas, false negative task based fMRI activation, termed neurovascular uncoupling, can potentially lead to the undesirable resection of eloquent areas. Neurovascular uncoupling may be identified with BOLD derived cerebrovascular reactivity (CVR), where impaired CVR results in decreased fMRI task-based activation in eloquent areas. Till now, CVR has not been spatially quantified for high-grade intracranial gliomas.

Method: Twelve subjects (mean age 55 ± 18) with high-grade gliomas (WHO grade III or IV) underwent a preoperative standardized hypercapnic challenge during 3T BOLD MRI acquisitions. The tumor was masked using an automated subtraction analysis based on (non)contrast enhanced T1-weighted and FLAIR T2 volumes. Voxels with FLAIR hyperintensities and a positive subtraction value were determined to be the tumor outline. Around the tumor, CVR was determined in 7 concentric rings with an individual expansion of 3mm. As comparison a mirror contralateral analysis was done. Furthermore, 10 healthy controls were included.

Results: Whole brain CVR of high-grade glioma subjects was significantly impaired compared to healthy controls (0.11 ± 0.10 versus 0.28 ± 0.8, p<0.01) Intratumoral CVR was 0.04 ± 0.07. Perifocal CVR exhibited an increasing CVR with every consecutive concentric ring expansion up to 12mm perifocally. However, this remained significantly impaired as to CVR measured in controls. No such trend was observed in the contralateral hemisphere.

Conclusions: Whole brain CVR of subjects with high-grade gliomas is impaired, with a more severe CVR impairment seen in tumor tissue and the first 12mm perifocally. No such trend was found on the contralateral side. BOLD-derived quantitative CVR measurements may provide a potential tool to assess neurovascular uncoupling in high-grade glioma.