Altered intraoperative cerebrovascular reactivity in brain areas of high-grade glioma recurrence.

INTRODUCTION Current MRI sequences are limited in identifying brain areas at risk for high grade glioma recurrence. We employed intraoperative 3-Tesla functional MRI to assess cerebrovascular reactivity (CVR) after high-grade glioma resection and analyzed regional CVR responses in areas of tumor recurrence on clinical follow-up imaging. METHODS Five subjects with high-grade glioma that underwent an intraoperative Blood Oxygen-Level Dependent (BOLD) MRI CVR examination and had a clinical follow-up of at least 18months were selected from a prospective database. For this study, location of tumor recurrence was spatially matched to the intraoperative imaging to assess CVR response in that particular area. CVR is defined as the percent BOLD signal change during repeated cycles of apnea. RESULTS Of the 5 subjects (mean age 44, 2 females), 4 were diagnosed with a WHO grade III and 1 subject with a WHO grade IV glioma. Three subjects exhibited a tumor recurrence on clinical follow-up MRI (mean: 15months). BOLD CVR measured in the spatially matched area of tumor recurrence was on average 94% increased (range-32% to 183%) as compared to contralateral hemisphere CVR response, 1.50±0.81 versus 1.03±0.46 respectively (p=0.31). CONCLUSION For this first analysis in a small cohort, we found altered intraoperative CVR in brain areas exhibiting high grade glioma recurrence on clinical follow-up imaging.

[1]  N. Galldiks,et al.  From the clinician's point of view - What is the status quo of positron emission tomography in patients with brain tumors? , 2015, Neuro-oncology.

[2]  B. Corn,et al.  Monitoring Brain Tumor Vascular Heamodynamic following Anti-Angiogenic Therapy with Advanced Magnetic Resonance Imaging in Mice , 2014, PloS one.

[3]  Wade M Mueller,et al.  Pseudo-reorganization of language cortical function at fMR imaging: a consequence of tumor-induced neurovascular uncoupling. , 2003, AJNR. American journal of neuroradiology.

[4]  A. Golby,et al.  Intraoperative Magnetic Resonance Imaging in Intracranial Glioma Resection: A Single-Center, Retrospective Blinded Volumetric Study. , 2015, World neurosurgery.

[5]  James Duffin,et al.  Approaches to Brain Stress Testing: BOLD Magnetic Resonance Imaging with Computer-Controlled Delivery of Carbon Dioxide , 2012, PloS one.

[6]  Benjamin M Ellingson,et al.  Comparison between intensity normalization techniques for dynamic susceptibility contrast (DSC)‐MRI estimates of cerebral blood volume (CBV) in human gliomas , 2012, Journal of magnetic resonance imaging : JMRI.

[7]  J. Madsen,et al.  3 Tesla intraoperative MRI for brain tumor surgery , 2014, Journal of magnetic resonance imaging : JMRI.

[8]  Pieter L Kubben,et al.  Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review. , 2011, The Lancet. Oncology.

[9]  Y. Hsu,et al.  Blood oxygenation level‐dependent MRI of cerebral gliomas during breath holding , 2004, Journal of magnetic resonance imaging : JMRI.

[10]  C. K. Mahutte,et al.  Arterial blood gas changes during breath-holding from functional residual capacity. , 1996, Chest.

[11]  A. Valavanis,et al.  Fine tuning breath‐hold‐based cerebrovascular reactivity analysis models , 2016, Brain and behavior.

[12]  D J Mikulis,et al.  Measuring cerebrovascular reactivity: what stimulus to use? , 2013, The Journal of physiology.

[13]  D J Mikulis,et al.  Cerebrovascular Reactivity Mapping: An Evolving Standard for Clinical Functional Imaging , 2015, American Journal of Neuroradiology.

[14]  Joseph A. Fisher,et al.  A conceptual model for CO2-induced redistribution of cerebral blood flow with experimental confirmation using BOLD MRI , 2014, NeuroImage.

[15]  R. Kauppinen,et al.  Blood oxygenation level dependent, blood volume, and blood flow responses to carbogen and hypoxic hypoxia in 9L rat gliomas as measured by MRI , 2014, Journal of magnetic resonance imaging : JMRI.

[16]  Dafna Ben Bashat,et al.  Hemodynamic Response Imaging: A Potential Tool for the Assessment of Angiogenesis in Brain Tumors , 2012, PloS one.

[17]  Susan M. Chang,et al.  Neuroimaging: diagnosis and response assessment in glioblastoma. , 2012, Cancer journal.