Failure of diffusion-weighted imaging in intraoperative 3 Tesla MRI to identify hyperacute strokes during glioma surgery

Voglis, Stefanos; Hiller, Aimee; Hofer, Anna‐Sophie; Tosic, Lazar; Bozinov, Oliver; Regli, Luca; Serra, Carlo

doi:10.1038/s41598-021-95505-6

Cited by 7 publications

(2 citation statements)

References 33 publications

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“…Especially in patients with a glioblastoma, the existence of perifocal DWI hyperintensities is a very poor prognostic factor [ 14 ], i.e., the complete resection of such diffusion-restricted tumor tissue is particularly important. A Swiss study showed the limitations of DWI and that intraoperative infarctions in particular can be overlooked or underestimated [ 15 ]. There are different study results on the existence and prognostic value of postoperative infarcts.…”

Section: Discussionmentioning

confidence: 99%

Comparison of EPI DWI and STEAM DWI in Early Postoperative MRI Controls After Resection of Tumors of the Central Nervous System

Müller

Khadhraoui

Voit³

et al. 2023

Clin Neuroradiol

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Purpose Diffusion-weighted imaging (DWI) is important for differentiating residual tumor and subacute infarctions in early postoperative magnetic resonance imaging (MRI) of central nervous system (CNS) tumors. In cases of pneumocephalus and especially in the presence of intraventricular trapped air, conventional echo-planar imaging (EPI) DWI is distorted by susceptibility artifacts. The performance and robustness of a newly developed DWI sequence using the stimulated echo acquisition mode (STEAM) was evaluated in patients after neurosurgical operations with early postoperative MRI. Methods We compared EPI and STEAM DWI of 43 patients who received 3‑Tesla MRI within 72 h after a neurosurgical operation between 1 October 2019 and 30 September 2021. We analyzed susceptibility artifacts originating from air and blood and whether these artifacts compromised the detection of ischemic changes after surgery. The DWI sequences were (i) visually rated and (ii) volumetrically analyzed. Results In 28 of 43 patients, we found severe and diagnostically relevant artifacts in EPI DWI, but none in STEAM DWI. In these cases, in which artifacts were caused by intracranial air, they led to a worse detection of ischemic lesions and thus to a possible failed diagnosis or lack of judgment using EPI DWI. Additionally, volumetric analysis demonstrated a 14% smaller infarct volume detected with EPI DWI. No significant differences in visual rating and volumetric analysis were detected among the patients without severe artifacts. Conclusion The newly developed version of STEAM DWI with highly undersampled radial encodings is superior to EPI DWI in patients with postoperative pneumocephalus.

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Section: Discussionmentioning

confidence: 99%

Comparison of EPI DWI and STEAM DWI in Early Postoperative MRI Controls After Resection of Tumors of the Central Nervous System

Müller

Khadhraoui

Voit³

et al. 2023

Clin Neuroradiol

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“… 36 However, it should be noted that there is a report that the hyperacute ischemic change could not be detected even by 3 T ioMR imaging. 37 Therefore, one cannot exclusively rely on ioMR to determine possible complications.…”

Section: Why Do Neurosurgeons Need Iomr Images?mentioning

confidence: 99%

Intraoperative MR Imaging during Glioma Resection

2022

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One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motorevoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.

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Comparison of Echo Planar and Turbo Spin Echo Diffusion‐Weighted Imaging in Intraoperative MRI

Thorpe,

Thust,

Gillon

et al. 2024

Magnetic Resonance Imaging

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BackgroundDiffusion‐weighted imaging (DWI) is routinely used in brain tumor surgery guided by intraoperative MRI (IoMRI). However, conventional echo planar imaging DWI (EPI‐DWI) is susceptible to distortion and artifacts that affect image quality. Turbo spin echo DWI (TSE‐DWI) is an alternative technique with minimal spatial distortions that has the potential to be the radiologically preferred sequence.PurposeTo compare via single‐ and multisequence assessment EPI‐DWI and TSE‐DWI in the IoMRI setting to determine whether there is a radiological preference for either sequence.Study TypeRetrospective.PopulationThirty‐four patients (22 female) aged 2–61 years (24 under 18 years) undergoing IoMRI during surgical resection of intracranial tumors.Field Strength/Sequence3‐T, EPI‐DWI, and TSE‐DWI.AssessmentPatients were scanned with EPI‐ and TSE‐DWI as part of the standard IoMRI scanning protocol. A single‐sequence assessment of spatial distortion and image artifact was performed by three neuroradiologists blinded to the sequence type. Images were scored regarding distortion and artifacts, around and remote to the resection cavity. A multisequence radiological assessment was performed by three neuroradiologists in full radiological context including all other IoMRI sequences from each case. The DWI images were directly compared with scorings of the radiologists on which they preferred with respect to anatomy, abnormality, artifact, and overall preference.Statistical TestsWilcoxon signed‐rank tests for single‐sequence assessment, weighted kappa for single and multisequence assessment. A P‐value <0.001 was considered statistically significant.ResultsFor the blinded single‐sequence assessment, the TSE‐DWI sequence was scored equal to or superior to the EPI‐DWI sequence for distortion and artifacts, around and remote to the resection cavity for every case. In the multisequence assessment, all radiologists independently expressed a preference for TSE‐DWI over EPI‐DWI sequences on viewing brain anatomy, abnormalities, and artifacts.Data ConclusionThe TSE‐DWI sequences may be favored over EPI‐DWI for IoMRI in patients with intracranial tumors.Level of Evidence2Technical EfficacyStage 5

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Failure of diffusion-weighted imaging in intraoperative 3 Tesla MRI to identify hyperacute strokes during glioma surgery

Cited by 7 publications

References 33 publications

Comparison of EPI DWI and STEAM DWI in Early Postoperative MRI Controls After Resection of Tumors of the Central Nervous System

Comparison of EPI DWI and STEAM DWI in Early Postoperative MRI Controls After Resection of Tumors of the Central Nervous System

Intraoperative MR Imaging during Glioma Resection

Comparison of Echo Planar and Turbo Spin Echo Diffusion‐Weighted Imaging in Intraoperative MRI

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