Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, National Neuroscience Institute, Singapore.
School of Pharmacy, MCPHS University, Boston, Massachusetts, USA.
World Neurosurg. 2021 May;149:232-243.e3. doi: 10.1016/j.wneu.2021.01.089. Epub 2021 Feb 2.
The benefit of intraoperative magnetic resonance imaging (iMRI) in gliomas remains unclear. We performed a meta-analysis of outcomes with iMRI-guided surgery in high-grade gliomas (HGGs) and low-grade gliomas (LGGs).
Databases were searched until November 29, 2018 for randomized controlled trials (RCTs) and observational studies (OBS) comparing iMRI use with conventional neurosurgery. Pooled risk ratios (RRs) or hazard ratios were evaluated with the random-effects model. Outcomes included extent of resection (EOR), gross total resection (GTR), progression-free survival (PFS), overall survival (OS), and length of surgery (LOS), stratified by study design and glioma grade.
Fifteen articles (3 RCTs and 12 OBS) were included. In RCTs, GTR was higher in iMRI compared with conventional neurosurgery (RR, 1.42; 95% confidence interval [CI], 1.17-1.73; I, 7%) overall, for LGGs (1.91; 95% CI, 1.19-3.06), but not HGGs (1.24; 95% CI, 0.89-1.73), with no difference in EOR, PFS, OS, and LOS. For OBS, GTR was higher (RR, 1.65; 95% CI, 1.43-1.90; I, 4%) overall, and for LGGs (1.63; 95% CI, 1.17-2.28; I, 0%) and HGGs (1.62; 95% CI, 1.36-1.92; I, 19%). EOR was greater with iMRI (6%; 95% CI, 4%-8%; I, 44%) overall, in LGGs (5%; 95% CI, 2%-8%; I, 37%) and HGGs (7%; 95% CI, 4%-10%; I, 13%). There was no difference in PFS, OS, and LOS with iMRI.
IMRI use improved GTR in gliomas, including LGGs. However, no PFS and OS benefit was shown in the meta-analysis.
术中磁共振成像（iMRI）在脑肿瘤中的获益仍不明确。我们对 iMRI 引导手术治疗高级别胶质瘤（HGG）和低级别胶质瘤（LGG）的结局进行了荟萃分析。
检索数据库至 2018 年 11 月 29 日，以纳入比较 iMRI 应用与常规神经外科手术的随机对照试验（RCT）和观察性研究（OBS）。采用随机效应模型评估汇总风险比（RR）或风险比。结局包括肿瘤切除程度（EOR）、大体全切除（GTR）、无进展生存期（PFS）、总生存期（OS）和手术时间（LOS），并按研究设计和胶质瘤分级进行分层。
纳入 15 项研究（3 项 RCT 和 12 项 OBS）。在 RCT 中，与常规神经外科手术相比，iMRI 组的 GTR 更高（RR，1.42；95%置信区间[CI]，1.17-1.73；I²，7%），总体而言，LGG 为 1.91（95%CI，1.19-3.06），但 HGG 并非如此（1.24；95%CI，0.89-1.73），EOR、PFS、OS 和 LOS 无差异。对于 OBS，总体 GTR 更高（RR，1.65；95%CI，1.43-1.90；I²，4%），LGG 和 HGG 也如此（1.63；95%CI，1.17-2.28；I²，0%）和 1.62（95%CI，1.36-1.92；I²，19%）。总体而言，iMRI 组的 EOR 更高（6%；95%CI，4%-8%；I²，44%），LGG 为 5%（95%CI，2%-8%；I²，37%）和 HGG 为 7%（95%CI，4%-10%；I²，13%）。PFS、OS 和 LOS 与 iMRI 无关。
iMRI 可提高脑肿瘤，包括 LGG 的 GTR，但荟萃分析未显示 PFS 和 OS 获益。
