Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.
Department of Neurosurgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.
Neurosurgery. 2020 Aug 1;87(2):238-246. doi: 10.1093/neuros/nyz398.
Intraoperative magnetic resonance imaging (IO-MRI) provides real-time assessment of extent of resection of brain tumor. Development of new enhancement during IO-MRI can confound interpretation of residual enhancing tumor, although the incidence of this finding is unknown.
To determine the frequency of new enhancement during brain tumor resection on intraoperative 3 Tesla (3T) MRI. To optimize the postoperative imaging window after brain tumor resection using 1.5 and 3T MRI.
We retrospectively evaluated 64 IO-MRI performed for patients with enhancing brain lesions referred for biopsy or resection as well as a subset with an early postoperative MRI (EP-MRI) within 72 h of surgery (N = 42), and a subset with a late postoperative MRI (LP-MRI) performed between 120 h and 8 wk postsurgery (N = 34). Three radiologists assessed for new enhancement on IO-MRI, and change in enhancement on available EP-MRI and LP-MRI. Consensus was determined by majority response. Inter-rater agreement was assessed using percentage agreement.
A total of 10 out of 64 (16%) of the IO-MRI demonstrated new enhancement. Seven of 10 patients with available EP-MRI demonstrated decreased/resolved enhancement. One out of 42 (2%) of the EP-MRI demonstrated new enhancement, which decreased on LP-MRI. Agreement was 74% for the assessment of new enhancement on IO-MRI and 81% for the assessment of new enhancement on the EP-MRI.
New enhancement occurs in intraoperative 3T MRI in 16% of patients after brain tumor resection, which decreases or resolves on subsequent MRI within 72 h of surgery. Our findings indicate the opportunity for further study to optimize the postoperative imaging window.
术中磁共振成像（IO-MRI）可实时评估脑肿瘤的切除范围。在 IO-MRI 中出现新的增强可能会混淆对残留增强肿瘤的解释，尽管这种发现的发生率尚不清楚。
确定脑肿瘤切除术中 3 特斯拉（3T）MRI 新增强的频率。使用 1.5 和 3T MRI 优化脑肿瘤切除术后的成像窗口。
我们回顾性评估了 64 例因增强性脑病变而接受活检或切除的患者进行 IO-MRI，其中包括术后 72 小时内进行早期术后 MRI（EP-MRI）的亚组（N=42）和术后 120 小时至 8 周进行晚期术后 MRI（LP-MRI）的亚组（N=34）。三位放射科医生在 IO-MRI 上评估新增强，以及在可用的 EP-MRI 和 LP-MRI 上的增强变化。通过多数响应确定共识。使用百分比协议评估组内一致性。
总共 64 例 IO-MRI 中有 10 例（16%）显示新增强。7 例 EP-MRI 中，10 例中有 7 例显示增强减少/消退。42 例 EP-MRI 中有 1 例（2%）显示新增强，LP-MRI 上的增强减少。IO-MRI 上新增强的评估的一致性为 74%，EP-MRI 上新增强的评估的一致性为 81%。
脑肿瘤切除术后，16%的患者在术中 3T MRI 中出现新增强，在术后 72 小时内的后续 MRI 上减少或消退。我们的研究结果表明，有机会进一步研究以优化术后成像窗口。
