Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures

Abstract

The goal in brain tumor surgery is to remove the maximum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been introduced, including an operating microscope in the late 1950s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resection cavity and thus overcome this remaining uncertainty of intraoperative MRI in high grade brain tumor resection.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words:Intraoperative magnetic resonance imaging; Dynamic susceptibility contrast magnetic resonance imaging; Dynamic contrast enhanced magnetic resonance imaging; Surgically induced contrast enhancement; Neurosurgery Core tip: The amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve maximum brain tumor removal, while preventing damage to "eloquent" brain regions, a variety of technical advances have been introduced, including intraoperative magnetic resonance imaging. Brain shift can thus be compensated; however, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired images. Recently, perfusion techniques (dynamic contrast enhanced magnetic resonance imaging, dynamic susceptibility contrast magnetic resonance imaging) have been introduced that can differentiate residual tumor from surgically induced changes and thus overcome this remaining uncertainty in high grade brain tumor resection.Ulmer S. Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures. World

A comparison of arterial spin labeling and dynamic susceptibility perfusion imaging for resection control in glioblastoma surgery

“…Resection control using MRI in a neurosurgical setting is commonly performed using T2w and native and contrast-enhanced T1w morphological imaging. In some cases, morphological imaging might be limited, hampered or even unlabeled, e.g., by a surgically induced temporary disrupted blood-brain-barrier, which leads to false-positive contrast enhancement of the resection margin and can thus impose itself as contrast-enhancing residual tumor tissue [ 22 ]. To compensate for this, intraoperative perfusion imaging using DSC (sometimes also dynamic contrast-enhanced, DCE) MRI was introduced.…”

Label-Free Neurosurgical Pathology with Stimulated Raman Imaging

“…Preoperative magnetic resonance images coregistered to the patient via neuronavigation systems is commonly used to guide surgery intraoperatively. However, resection of tumor tissue causes the surrounding brain to shift, which increasingly reduces spatial accuracy (3). Moreover, while MRI is the gold standard for delineating tumor boundaries, tumor cells invariably extend beyond the MRI signal abnormality (4).…”

T1-Weighted Contrast Enhancement, Apparent Diffusion Coefficient, and Cerebral-Blood-Volume Changes after Glioblastoma Resection: MRI within 48 Hours vs. beyond 48 Hours

“…There is evidence, in the literature, of an increased occurrence of MRI changes caused by the surgical manipulation of the brain parenchyma [ 30 , 33 , 34 ]. Surgically induced changes become pronounced beyond 72 h [ 13 , 35 , 36 , 37 ], but may already be present in the first 48 h [ 13 , 33 ].…”