Article
Reliable? The value of early postoperative magnetic resonance imaging after CCM surgery
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Authors
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Bixia Chen
- Klinik für Neurochirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Universität Duisburg-Essen, Essen, Deutschland
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Sophia Göricke
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
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Karsten H. Wrede
- Klinik für Neurochirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Universität Duisburg-Essen, Essen, Deutschland
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Ramazan Jabbarli
- Klinik für Neurochirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
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Ulrich Sure
- Klinik für Neurochirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
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Philipp Dammann
- Klinik für Neurochirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Cerebral cavernous malformations (CCM) can cause intracerebral hemorrhage. The lesions themselves are frequently associated with perifocal hemosiderin deposits due to repetitive microhemorrhages. Main indications for a surgical treatment are recurrent symptomatic hemorrhages or cavernoma-related epilepsy (CRE). After surgical resection, follow-up MR-imaging is usually performed to confirm a) the complete resection of the CCM and, especially in cases of CRE, b) the complete resection of the hemosiderin deposits. This prospective study evaluates the value of early postoperative MRI regarding the detection of CCM or hemosiderin remnants compared to a “standard” 3-6 months postoperative MRI control.
Methods: In 61 surgically treated CCM cases (including 3 spinal cases), early postoperative MRI (within 72 hours) and follow-up MR images (after 3-6 months) were acquired. All imaging was performed on whole-body 1.5 Tesla MRI systems. MR sequences included T1, T2, and hemosensitive (T2*/SWI) sequences. MR images were evaluated by two experiences raters in consensus reading. Early postoperative and follow-up MRI images were assessed focusing on presence of CCM remnant, and hemosiderin remnant. Calculations of sensitivity, specificity, positive predictive value, and negative predictive value were performed for the early postoperative MRI, compared to the late postoperative MRI as reference results.
Results: Overall image quality was good for both early postoperative MRI and follow-up MRI. Sensitivity of early postoperative MRI for CCM remnant detection was 66.67% (95% CI 9.43% - 99.16%), specificity was 76.74% (95% CI 61.37% - 88.24%), positive predictive value was 16.67% (95% CI 2.09% – 48.41%) and negative predictive value was 97.06% (95% CI 84.67% - 99.93%). Due to the high number of patients that could not be evaluated due to imaging artifacts caused by surgical artifacts (air, blood, hemostyptics), sensitivity and specificity analysis was not performed for early postoperative MRI using T2*/SWI to assess hemosiderin remnants. Sensitivity of early postoperative MRI for hemosiderin remnant detection using T2 weighted sequences was 90.0% (95% CI 68.30% - 98.77%), specificity was 46.67% (95% CI 21.27% - 73.41%), positive predictive value was 69.23% (95% CI 48.21% – 85.67%) and negative predictive value was 77.78% (95% CI 39.99% - 97.19%).
Conclusion: Our data suggests that early postoperative MRI after CCM surgery is often hampered by imaging artefacts and therefore ineligible for a resection control.
