Heßelmann Volker, Mager Ann-Kathrin, Goetz Claudia, Detsch Oliver, Theisgen Hannah-Katharina, Friese Michael, Schwindt Wolfram, Gottschalk Joachim, Kremer Paul
Radiology/Neurologie, Asklepios-Klinik Hamburg-Nord, Hamburg, Germany.
Department of Neurosurgery, Asklepios Klinik Nord, Hamburg, Germany.
Rofo. 2017 Jun;189(6):519-526. doi: 10.1055/s-0043-106189. Epub 2017 Jun 7.
To assess the sensitivity/specificity of tumor detection by T1 contrast enhancement in intraoperative MRI (ioMRI) in comparison to histopathological assessment as the gold standard in patients receiving surgical resection of grade IV glioblastoma. 68 patients with a primary or a recurrent glioblastoma scheduled for surgery including fluorescence guidance and neuronavigation were included (mean age: 59 years, 26 female, 42 male patients). The ioMRI after the first resection included transverse FLAIR, DWI, T2-FFE and T1 - 3 d FFE +/- GD-DPTA. The second resection was performed whenever residual contrast-enhancing tissue was detected on ioMRI. Resected tissue samples were histopathologically evaluated (gold standard). Additionally, we evaluated the early postoperative MRI scan acquired within 48 h post-OP for remaining enhancing tissue and compared them with the ioMRI scan. In 43 patients ioMRI indicated residual tumorous tissue, which could be confirmed in the histological specimens of the second resection. In 16 (4 with recurrent, 12 with primary glioblastoma) cases, ioMRI revealed truly negative results without residual tumor and follow-up MRI confirmed complete resection. In 7 cases (3 with recurrent, 4 with primary glioblastoma) ioMRI revealed a suspicious result without tumorous tissue in the histopathological workup. In 2 (1 for each group) patients, residual tumorous tissue was detected in spite of negative ioMRI. IoMRI had a sensitivity of 95 % (94 % recurrent and 96 % for primary glioblastoma) and a specificity of 69.5 % (57 % and 75 %, respectively). The positive predictive value was 86 % (84 % for recurrent and 87 % for primary glioblastoma), and the negative predictive value was 88 % (80 % and 92 %, respectively). ioMRI is effective for detecting remaining tumorous tissue after glioma resection. However, scars and leakage of contrast agent can be misleading and limit specificity. · Intraoperative MRI (ioMRI) presents with a high sensitivity for residual contrast-enhancing tumorous tissue during glioma resection.. · Contrast leakage due to bleeding and scars with reactive contrast enhancement can cause possible misleading artifacts in ioMRI, leading to a limited specificity of ioMRI.. · Bleeding control in glioma resection is crucial for successful usage of ioMRO for glioma resection.. · Heßelmann V, Mager A, Goetz C et al. Accuracy of High-Field Intraoperative MRI in the Detectability of Residual Tumor in Glioma Grade IV Resections. Fortschr Röntgenstr 2017; 189: 519 - 526.
以组织病理学评估作为金标准，评估术中磁共振成像（ioMRI）中T1对比增强检测肿瘤的敏感性/特异性，研究对象为接受IV级胶质母细胞瘤手术切除的患者。纳入68例计划接受包括荧光引导和神经导航的手术的原发性或复发性胶质母细胞瘤患者（平均年龄：59岁，女性26例，男性42例）。首次切除术后的ioMRI包括横轴位液体衰减反转恢复序列（FLAIR）、弥散加权成像（DWI）、T2加权快速场回波序列（T2-FFE）和T1加权三维快速场回波序列（T1-3d FFE）+/-钆喷酸葡胺（GD-DPTA）。只要在ioMRI上检测到残留的对比增强组织，就进行二次切除。对切除的组织样本进行组织病理学评估（金标准）。此外，我们评估了术后48小时内获得的早期术后MRI扫描中残留的增强组织，并将其与ioMRI扫描结果进行比较。43例患者的ioMRI显示有残留肿瘤组织，这在二次切除的组织学标本中得到证实。16例（4例复发性胶质母细胞瘤，12例原发性胶质母细胞瘤）患者的ioMRI显示真正的阴性结果，无残留肿瘤，随访MRI证实为完全切除。7例（3例复发性胶质母细胞瘤，4例原发性胶质母细胞瘤）患者的ioMRI显示可疑结果，组织病理学检查未发现肿瘤组织。2例患者（每组1例）尽管ioMRI为阴性，但仍检测到残留肿瘤组织。ioMRI的敏感性为95%（复发性胶质母细胞瘤为94%，原发性胶质母细胞瘤为96%），特异性为69.5%（分别为57%和75%）。阳性预测值为86%（复发性胶质母细胞瘤为84%，原发性胶质母细胞瘤为87%），阴性预测值为88%（分别为80%和92%）。ioMRI对胶质瘤切除术后残留肿瘤组织的检测有效。然而，瘢痕和造影剂渗漏可能会产生误导，限制特异性。·术中磁共振成像（ioMRI）对胶质瘤切除术中残留的对比增强肿瘤组织具有高敏感性。·出血和瘢痕引起的造影剂渗漏以及反应性对比增强可在ioMRI中导致可能的误导性伪影，导致ioMRI的特异性受限。·胶质瘤切除术中的出血控制对于ioMRO成功用于胶质瘤切除至关重要。·Heßelmann V, Mager A, Goetz C等。高场术中磁共振成像在IV级胶质瘤切除术中检测残留肿瘤的准确性。Fortschr Röntgenstr 2017; 189: 519 - 526。
