Intraoperative 3 T MRI is more correlative to residual disease extent than early postoperative MRI

• Published in: Journal of neuro-oncology Vol. 154; no. 3; pp. 345 - 351
• Main Authors: Huntoon, Kristin, Makary, Mina S., Damante, Mark, Giglio, Pierre, Slone, Wayne, Elder, J. Bradley
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2021; Springer Nature B.V
• Subjects: Brain Neoplasms - diagnostic imaging; Brain Neoplasms - surgery; Clinical Study; Disease Progression; Glioma; Glioma - diagnostic imaging; Glioma - surgery; Humans; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Neoplasm, Residual - diagnostic imaging; Neoplasm, Residual - surgery; Neurology; Oncology; Patients; Retrospective Studies; Intraoperative MRI; Low grade glioma
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-021-03833-4

Purpose Extent of resection of low grade glioma (LGG) is an important prognostic variable, and may influence decisions regarding adjuvant therapy in certain patient populations. Immediate postoperative magnetic resonance image (MRI) is the mainstay for assessing residual tumor. However, previous studies have suggested that early postoperative MRI fluid-attenuated inversion recovery (FLAIR) (within 48 h) may overestimate residual tumor volume in LGG. Intraoperative magnetic resonance imaging (iMRI) without subsequent resection may more accurately assess residual tumor. Consistency in MRI techniques and utilization of higher magnet strengths may further improve both comparisons between MRI studies performed at different time points as well as the specificity of MRI findings to identify residual tumor. To evaluate the utility of 3 T iMRI in the imaging of LGG, we volumetrically analyzed intraoperative, early, and late (~ 3 months after surgery) postoperative MRIs after resection of LGG. Methods A total of 32 patients with LGG were assessed retrospectively. Residual tumor was defined as hyperintense T2 signal on FLAIR. Volumetric assessment was performed with intraoperative, early, and late postoperative FLAIR via TeraRecon iNtuition. Results Perilesional FLAIR parenchymal abnormality volumes were significantly different comparing intraoperative and early postoperative MRI (2.17 ± 0.45 cm 3 vs. 5.47 ± 1.07 cm 3 , respectively (p = 0.0002)). A significant difference of perilesional FLAIR parenchymal abnormality volumes was also found comparing early and late postoperative MRI (5.47 ± 1.07 cm 3 vs. 3.22 ± 0.64 cm 3 , respectively (p = 0.0001)). There was no significant difference between intraoperative and late postoperative Perilesional FLAIR parenchymal abnormality volumes. Conclusions Intraoperative 3 T MRI without further resection appears to better reflect the volume of residual tumor in LGG compared with early postoperative 3 T MRI. Early postoperative MRI may overestimate residual tumor. As such, intraoperative MRI performed after completion of tumor resection may be more useful for making decisions regarding adjuvant therapy.