Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
BMC Cancer. 2020 May 12;20(1):410. doi: 10.1186/s12885-020-06897-z.
Neurosurgical resection represents an important treatment option in the modern, multimodal therapy approach of brain metastases (BM). Guidelines for perioperative imaging exist for primary brain tumors to guide postsurgical treatment. Optimal perioperative imaging of BM patients is so far a matter of debate as no structured guidelines exist.
A comprehensive questionnaire about perioperative imaging was designed by the European Association of Neuro-Oncology (EANO) Youngsters Committee. The survey was distributed to physicians via the EANO network to perform a descriptive overview on the current habits and their variability on perioperative imaging. Chi square test was used for dichotomous variables.
One hundred twenty physicians worldwide responded to the survey. MRI was the preferred preoperative imaging method (93.3%). Overall 106/120 (88.3%) physicians performed postsurgical imaging routinely including MRI alone (62/120 [51.7%]), postoperative CT (29/120 [24.2%]) and MRI + CT (15/120 [12.5%]). No correlation of postsurgical MRI utilization in academic vs. non-academic hospitals (58/89 [65.2%] vs. 19/31 [61.3%], p = 0.698) was found. Early postoperative MRI within ≤72 h after resection is obtained by 60.8% of the participants. The most frequent reason for postsurgical imaging was to evaluate the extent of tumor resection (73/120 [60.8%]). In case of residual tumor, 32/120 (26.7%) participants indicated to adjust radiotherapy, 34/120 (28.3%) to consider re-surgery to achieve complete resection and 8/120 (6.7%) to evaluate both.
MRI was the preferred imaging method in the preoperative setting. In the postoperative course, imaging modalities and timing showed high variability. International guidelines for perioperative imaging with special focus on postoperative MRI to assess residual tumor are warranted to optimize standardized management and adjuvant treatment decisions for BM patients.
神经外科切除术是脑转移瘤（BM）现代多模式治疗方法的重要治疗选择。针对原发性脑肿瘤，存在围手术期影像学检查指南，以指导术后治疗。目前，BM 患者的最佳围手术期影像学检查仍存在争议，因为没有结构化的指南。
欧洲神经肿瘤学会（EANO）青年委员会设计了一份关于围手术期影像学检查的综合问卷。该调查通过 EANO 网络分发给医生，以了解当前的习惯及其在围手术期影像学检查方面的变异性。二项变量采用卡方检验。
全球有 120 名医生对该调查做出了回应。MRI 是首选的术前影像学检查方法（93.3%）。总体而言，有 106/120（88.3%）名医生常规进行术后影像学检查，包括单独 MRI（62/120[51.7%]）、术后 CT（29/120[24.2%]）和 MRI+CT（15/120[12.5%]）。在学术医院和非学术医院之间，术后 MRI 的使用并没有相关性（58/89[65.2%]与 19/31[61.3%]，p=0.698）。术后≤72 小时内进行早期 MRI 检查的比例为 60.8%。术后影像学检查最常见的原因是评估肿瘤切除范围（73/120[60.8%]）。对于残留肿瘤，32/120（26.7%）的参与者表示要调整放疗，34/120（28.3%）考虑再次手术以达到完全切除，8/120（6.7%）评估两者。
MRI 是术前首选的影像学检查方法。在术后阶段，影像学方式和时间存在很大的差异。需要制定针对围手术期影像学检查的国际指南，特别关注术后 MRI 以评估残留肿瘤，以优化 BM 患者的标准化管理和辅助治疗决策。
