High-field intraoperative MRI in glioma surgery: A prospective study with volumetric analysis of extent of resection and functional outcome - 19/07/18
, C. Delmaire c, E. Le Rhun a, E. Drumez d, J.-P. Lejeune a, N. Reyns a, bBienvenue sur EM-consulte, la référence des professionnels de santé.
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Abstract |
Background |
High-field intraoperative MRI (IoMRI) is a useful tool to improve the extent of glioma resection (EOR).
Objective |
To compare the interest of 1.5T IoMRI in glioma surgery between enhancing and non-enhancing tumors, based on volumetric analysis.
Methods |
A prospective single-center study included consecutive adult patients undergoing glioma surgery with IoMRI. Volumetric evaluation was based on FLAIR hypersignal after gadolinium injection in non-enhancing tumors and T1 hypersignal after gadolinium injection in enhancing tumors. Endpoints comprised: residual tumor volume (RTV), EOR, workflow and clinical outcome on Karnofsky performance score (KPS).
Results |
Fifty-three surgeries were performed from July 2014 to January 2016. Thirty-four patients underwent one IoMRI, and 19 two IoMRIs. In non-enhancing tumors, intraoperative RTV on 1st IoMRI T2/FLAIR was higher than in enhancing tumors on T1 sequences (7.25cm3 vs. 0.74cm3, respectively; P=0.008), whereas the RTV on 2nd IoMRIs and final RTV were no longer significantly different. After IoMRI, 72% of patients underwent additional resection. In non-enhancing tumors, EOR increased from 77.3% on 1st IoMRI to 97.4% on last MRI (P<0.001). Taking all tumors together, final RTV values were: median=0cm3, mean=3.9cm3. Mean final EOR was 94%. In 25% of patients, KPS was reduced during early postoperative course; at 3 and 6 months postoperatively, median KPS was 90.
Conclusion |
Intraoperative MRI guidance significantly enhanced the extent of glioma resection, especially for non- or minimally enhancing tumors, while preserving patient autonomy.
Le texte complet de cet article est disponible en PDF.Keywords : High-field intraoperative MRI, Low-grade glioma, Extent of resection, Functional outcome
Plan
Vol 64 - N° 3
P. 155-160 - juin 2018 Retour au numéro
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