Survival Implications of Postoperative Restricted Diffusion in High-Grade Glioma and Limitations of Intraoperative MRI Detection

Authors

• Daniel M. Aaronson, Medical College of Wisconsin
• Brandon Laing, Medical College of Wisconsin
• Ishan Singhal, Medical College of Wisconsin
• Timothy F. Boerger, Medical College of Wisconsin
• Ryan T. Beck, Medical College of Wisconsin
• Wade M. Mueller, Medical College of Wisconsin
• Max O. Krucoff, Marquette University

Document Type

Article

Publication Date

9-2024

Publisher

Springer

Source Publication

Journal of Neuro-Oncology

Source ISSN

0167-594X

Original Item ID

DOI: 10.1007/s11060-024-04767-3

Abstract

Purpose

Here we assess whether the volume of cerebral ischemia induced during glioma surgery may negatively impact survival independently of neurological function. We also evaluate the sensitivity of intraoperative MRI (iMRI) in detecting cerebral ischemia during surgery.

Methods

We retrospectively reviewed 361 cranial surgeries that used a 3 Tesla iMRI. 165 patients met all inclusion criteria and were included in the final analysis. Diffusion weighted imaging (DWI) obtained during iMRI was compared to postoperative DWI obtained within 7 days of the operation in cases where no further resection occurred after the iMRI.

Results

42 of 165 patients (25%) showed at least some evidence of restricted diffusion on postoperative (poMRI). 37 of these 42 (88%) cases lacked evidence of restricted diffusion on iMRI, meaning iMRI had a false-negative rate of 88% and a sensitivity of 12% in assessing the extent of ischemic brain after surgery. In high-grade gliomas, the volume of restricted diffusion on poMRI was predictive of overall survival, independent of new functional deficits acquired during surgery (p = 0.011).

Conclusion

This study presents the largest case series to date analyzing the sensitivity of iMRI in detecting surgical ischemia. In high-grade gliomas, increased volume of ischemia correlated with worsening median overall survival (OS) irrespective of postoperative neurologic deficits. Future work will focus on improving intraoperative detection of ischemia during the hyperacute phase when interventions such as blood pressure modulation or direct application of vasodilator agents may be effective.

Comments

Journal of Neuro-Oncology, Vol. 170, No. 2 (2024, September): 419-428. DOI.

Recommended Citation

Aaronson, Daniel M.; Laing, Brandon; Singhal, Ishan; Boerger, Timothy F.; Beck, Ryan T.; Mueller, Wade M.; and Krucoff, Max O., "Survival Implications of Postoperative Restricted Diffusion in High-Grade Glioma and Limitations of Intraoperative MRI Detection" (2024). Biomedical Engineering Faculty Research and Publications. 724.
https://epublications.marquette.edu/bioengin_fac/724