Department of Neurosurgery, Shinshu University School of Medicine.
Department of Neurosurgery, Saint Marianna University School of Medicine.
J Nippon Med Sch. 2022 Jun 28;89(3):269-276. doi: 10.1272/jnms.JNMS.2022_89-301. Epub 2021 Sep 14.
Intraoperative magnetic resonance imaging (MRI) is useful for identifying residual tumors during surgery. It can improve the resection rate; however, complications related to prolonged operating time may be increased. We assessed the advantages and disadvantages of using low-field intraoperative MRI and compared them with non-use of iMRI during glioma surgery.
The study included 22 consecutive patients who underwent total tumor resection at Shinshu University Hospital between September 2017 and October 2020. Patients were divided into two groups (before and after introducing 0.4-T low-field open intraoperative MRI at the hospital). Patient demographics, gross total resection (GTR) rate, postoperative neurological deficits, need for reoperation, and operating time were compared between the groups.
No significant differences were observed in patient demographics. While GTR of the tumor was achieved in 8/11 cases (73%) with intraoperative MRI, 2/11 cases (18%) of the control group achieved GTR (p=0.033). Seven patients had transient neurological deficits: 3 in the intraoperative MRI group and 4 in the control group, without significant differences between groups. There was no unintended reoperation in the intraoperative MRI group, except for one case in the control group. Mean operating time (465.8 vs. 483.6 minutes for the intraoperative MRI and control groups, respectively) did not differ.
Low-field intraoperative MRI improves the GTR rate and reduces unintentional reoperation incidence compared to the conventional technique. Our findings showed no operating time prolongation in the MRI group despite intraoperative imaging, which considered that intraoperative MRI helped reduce decision-making time and procedural hesitation during surgery.
术中磁共振成像（MRI）有助于在手术中识别残留肿瘤。它可以提高切除率；然而，与延长手术时间相关的并发症可能会增加。我们评估了在神经胶质瘤手术中使用低场术中 MRI 的优缺点，并将其与不使用 iMRI 进行了比较。
这项研究纳入了 2017 年 9 月至 2020 年 10 月在信州大学医院接受全肿瘤切除术的 22 例连续患者。患者被分为两组（医院引入 0.4-T 低场开放式术中 MRI 前后）。比较两组患者的人口统计学资料、肿瘤全切除率（GTR）、术后神经功能缺损、再次手术的需要和手术时间。
患者的人口统计学资料无显著差异。在术中 MRI 组，11 例中有 8 例（73%）实现了肿瘤 GTR，而对照组中有 2 例（18%）实现了 GTR（p=0.033）。7 例患者出现短暂性神经功能缺损：术中 MRI 组 3 例，对照组 4 例，两组间无显著差异。术中 MRI 组无一例意外再次手术，对照组有一例。平均手术时间（术中 MRI 组为 465.8 分钟，对照组为 483.6 分钟）无差异。
与常规技术相比，低场术中 MRI 可提高 GTR 率并降低意外再次手术的发生率。我们的研究结果表明，尽管术中进行了成像，但 MRI 组的手术时间没有延长，这表明术中 MRI 有助于减少手术期间的决策时间和手术犹豫。
