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Frequency and Evolution of New Postoperative Enhancement on 3 Tesla Intraoperative and Early Postoperative Magnetic Resonance Imaging.

Authors
  • Miskin, Nityanand1
  • Unadkat, Prashin1, 2, 3
  • Carlton, Michael E1
  • Golby, Alexandra J1, 2
  • Young, Geoffrey S1
  • Huang, Raymond Y1
  • 1 Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.
  • 2 Department of Neurosurgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.
  • 3 Department of Surgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.
Type
Published Article
Journal
Neurosurgery
Publication Date
Aug 01, 2020
Volume
87
Issue
2
Pages
238–246
Identifiers
DOI: 10.1093/neuros/nyz398
PMID: 31584071
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Intraoperative magnetic resonance imaging (IO-MRI) provides real-time assessment of extent of resection of brain tumor. Development of new enhancement during IO-MRI can confound interpretation of residual enhancing tumor, although the incidence of this finding is unknown. To determine the frequency of new enhancement during brain tumor resection on intraoperative 3 Tesla (3T) MRI. To optimize the postoperative imaging window after brain tumor resection using 1.5 and 3T MRI. We retrospectively evaluated 64 IO-MRI performed for patients with enhancing brain lesions referred for biopsy or resection as well as a subset with an early postoperative MRI (EP-MRI) within 72 h of surgery (N = 42), and a subset with a late postoperative MRI (LP-MRI) performed between 120 h and 8 wk postsurgery (N = 34). Three radiologists assessed for new enhancement on IO-MRI, and change in enhancement on available EP-MRI and LP-MRI. Consensus was determined by majority response. Inter-rater agreement was assessed using percentage agreement. A total of 10 out of 64 (16%) of the IO-MRI demonstrated new enhancement. Seven of 10 patients with available EP-MRI demonstrated decreased/resolved enhancement. One out of 42 (2%) of the EP-MRI demonstrated new enhancement, which decreased on LP-MRI. Agreement was 74% for the assessment of new enhancement on IO-MRI and 81% for the assessment of new enhancement on the EP-MRI. New enhancement occurs in intraoperative 3T MRI in 16% of patients after brain tumor resection, which decreases or resolves on subsequent MRI within 72 h of surgery. Our findings indicate the opportunity for further study to optimize the postoperative imaging window. Copyright © 2019 by the Congress of Neurological Surgeons.

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