Early postoperative MRI overestimates residual tumour after resection of gliomas with no or minimal enhancement

BackgroundStandards for residual tumour measurement after resection of gliomas with no or minimal enhancement have not yet been established. In this study residual volumes on early and late postoperative T2-/FLAIR-weighted MRI are compared.MethodsA retrospective cohort included 58 consecutive glioma patients with no or minimal preoperative gadolinium enhancement. Inclusion criteria were first-time resection between 2007 and 2009 with a T2-/FLAIR-based target volume and availability of preoperative, early (<48 h) and late (1–7 months) postoperative MRI. The volumes of non-enhancing T2/FLAIR tissue and diffusion restriction areas were measured.ResultsResidual tumour volumes were 22% smaller on late postoperative compared with early postoperative T2-weighted MRI and 49% smaller for FLAIR-weighted imaging. Postoperative restricted diffusion volume correlated with the difference between early and late postoperative FLAIR volumes and with the difference between T2 and FLAIR volumes on early postoperative MRI.ConclusionWe observed a systematic and substantial overestimation of residual non-enhancing volume on MRI within 48 h of resection compared with months postoperatively, in particular for FLAIR imaging. Resection-induced ischaemia contributes to this overestimation, as may other operative effects. This indicates that early postoperative MRI is less reliable to determine the extent of non-enhancing residual glioma and restricted diffusion volumes are imperative.

[1]  K Sartor,et al.  Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. , 1994, Neurosurgery.

[2]  M. Berger,et al.  GLIOMA EXTENT OF RESECTION AND ITS IMPACT ON PATIENT OUTCOME , 2008, Neurosurgery.

[3]  Luc Taillandier,et al.  Preoperative estimation of residual volume for WHO grade II glioma resected with intraoperative functional mapping. , 2007, Neuro-oncology.

[4]  Gereon R Fink,et al.  Development of brain infarct volume as assessed by magnetic resonance imaging (MRI): Follow‐up of diffusion‐weighted MRI lesions , 2004, Journal of magnetic resonance imaging : JMRI.

[5]  G. Fuller,et al.  The significance of lack of MR contrast enhancement of supratentorial brain tumors in adults: histopathological evaluation of a series. , 1998, Surgical neurology.

[6]  Tracy T Batchelor,et al.  Comparison of linear and volumetric criteria in assessing tumor response in adult high-grade gliomas. , 2006, Neuro-oncology.

[7]  M. Scerrati,et al.  Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[8]  A. Rezvan,et al.  Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients , 2009, Acta Neurochirurgica.

[9]  S. Schoenberg,et al.  Cerebral gliomas and metastases: assessment with contrast-enhanced fast fluid-attenuated inversion-recovery MR imaging. , 1999, Radiology.

[10]  Susan M. Chang,et al.  Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  H. Köstler,et al.  Diagnostic value of the fast-FLAIR sequence in MR imaging of intracranial tumors , 2000, European Radiology.

[12]  A G Sorensen,et al.  Comparison of diameter and perimeter methods for tumor volume calculation. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  Veit Rohde,et al.  EXTENT OF RESECTION AND SURVIVAL IN GLIOBLASTOMA MULTIFORME: IDENTIFICATION OF AND ADJUSTMENT FOR BIAS , 2008, Neurosurgery.

[14]  Susan M. Chang,et al.  Serial diffusion-weighted magnetic resonance imaging in cases of glioma: distinguishing tumor recurrence from postresection injury. , 2005, Journal of neurosurgery.

[15]  C. Gerloff,et al.  Negative fluid‐attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less , 2009, Annals of neurology.

[16]  T M Mayhew,et al.  Magnetic resonance imaging (MRI) and model-free estimates of brain volume determined using the Cavalieri principle. , 1991, Journal of anatomy.

[17]  J. Britton,et al.  FLAIR imaging in the follow-up of low-grade gliomas: time to dispense with the dual-echo? , 2001, Neuroradiology.

[18]  M. Berger,et al.  The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas , 1994, Cancer.

[19]  M E Moseley,et al.  Evolution of apparent diffusion coefficient, diffusion-weighted, and T2-weighted signal intensity of acute stroke. , 2001, AJNR. American journal of neuroradiology.

[20]  H Duffau,et al.  Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[21]  M. Knopp,et al.  Postoperative fluid-attenuated inversion recovery MR imaging of cerebral gliomas: initial results , 2001, European Radiology.

[22]  R. Sevick,et al.  How often are nonenhancing supratentorial gliomas malignant? A population study , 2002, Neurology.

[23]  E. Shaw,et al.  Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial. , 2008, Journal of neurosurgery.

[24]  Elizabeth Eisenhauer,et al.  Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. , 2008, The Lancet. Oncology.

[25]  M. Endres,et al.  Fluid-Attenuated Inversion Recovery Evolution Within 12 Hours From Stroke Onset: A Reliable Tissue Clock? , 2010, Stroke.

[26]  Susan M. Chang,et al.  Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. , 2008, Journal of neurosurgery.

[27]  B. Scheithauer,et al.  The 2007 WHO classification of tumours of the central nervous system , 2007, Acta Neuropathologica.

[28]  Susan M. Chang,et al.  Age and the risk of anaplasia in magnetic resonance‐nonenhancing supratentorial cerebral tumors , 1997, Cancer.

[29]  D. Louis.  WHO classification of tumours of the central nervous system , 2007 .

[30]  Kim Mouridsen,et al.  Quantitative t2 values predict time from symptom onset in acute stroke patients. , 2009, Stroke.

[31]  Henry Brem,et al.  EXTENT OF SURGICAL RESECTION IS INDEPENDENTLY ASSOCIATED WITH SURVIVAL IN PATIENTS WITH HEMISPHERIC INFILTRATING LOW‐GRADE GLIOMAS , 2008, Neurosurgery.