Altered intraoperative cerebrovascular reactivity in brain areas of high-grade glioma recurrence

Abstract

INTRODUCTION: Current MRI sequences are limited in identifying brain areas at risk for high grade glioma recurrence. We employed intraoperative 3-Tesla functional MRI to assess cerebrovascular reactivity (CVR) after high-grade glioma resection and analyzed regional CVR responses in areas of tumor recurrence on clinical follow-up imaging. METHODS: Five subjects with high-grade glioma that underwent an intraoperative Blood Oxygen-Level Dependent (BOLD) MRI CVR examination and had a clinical follow-up of at least 18 months were selected from a prospective database. For this study, location of tumor recurrence was spatially matched to the intraoperative imaging to assess CVR response in that particular area. CVR is defined as the percent BOLD signal change during repeated cycles of apnea. RESULTS: Of the 5 subjects (mean age 44, 2 females), 4 were diagnosed with a WHO grade III and 1 subject with a WHO grade IV glioma. Three subjects exhibited a tumor recurrence on clinical follow-up MRI (mean: 15 months). BOLD CVR measured in the spatially matched area of tumor recurrence was on average 94% increased (range -32% to 183%) as compared to contralateral hemisphere CVR response, 1.50±0.81 versus 1.03±0.46 respectively (p=0.31). CONCLUSION: For this first analysis in a small cohort, we found altered intraoperative CVR in brain areas exhibiting high grade glioma recurrence on clinical follow-up imaging. Methods: Five subjects with high-grade glioma that underwent an intraoperative BloodOxygen-Level Dependent (BOLD) MRI CVR examination and had a clinical follow-up of at least 18 months were selected from a prospective database. For this study, location of tumor recurrence was spatially matched to the intraoperative imaging to assess CVR response in that particular area. CVR is defined as the percent BOLD signal change during repeated cycles of apnea.Results: Of the 5 subjects (mean age 44, 2 females), 4 were diagnosed with a WHO grade III and 1 subject with a WHO grade IV glioma. Three subjects exhibited a tumor recurrence on clinical follow-up MRI (mean: 15 months). BOLD CVR measured in the spatially matched area of tumor recurrence was on average 64% increased (range -29% to 123%) as compared to whole brain CVR response, 1.50±0.81 versus 1.09±0.37 respectively. Conclusion:For this first analysis in a small cohort, we found altered intraoperative CVR in brain areas exhibiting high grade glioma recurrence on clinical follow-up imaging.

Intraoperative BOLD-fMRI Cerebrovascular Reactivity Assessment

“…2012-0427) and all participants signed informed consent prior to the study. An attempt to measure BOLD-CVR intraoperatively was first accomplished in oncological patients [11,12]. Considering the technical issues associated with obtaining controlled iso-oxic hypercapnic stimuli and the need of a cooperative patient for this purpose [1], only breath-holding tasks were feasible so far to obtain CO 2 raises in unconscious patients.…”

“…The clinical relevance of CVR in predicting stroke risk has been confirmed, and CVR is widely investigated with different techniques, allowing risk stratification and providing valuable information for therapeutic decision-making [9,10]. We have recently proposed and tested an intraoperative CVR assessment to obtain early information that could potentially help during the surgical procedure [11,12]. CVR can be studied by applying a vasoactive stimulus to a patient and measuring the resulting changes at the brain level, either by CBF modifications or by surrogate of blood flow.…”

Crossed Cerebellar Diaschisis in Patients with Diffuse Glioma Is Associated with Impaired Supratentorial Cerebrovascular Reactivity and Worse Clinical Outcome

“…Blood oxygenation level–dependent fMRI (BOLD)-CVR with a standardized carbon dioxide (CO 2 ) stimulus [ 5 , 6 ] is a contemporary technique for investigating CVR impairment in patients with diffuse glioma [ 7 , 8 ]. It has also shown its utility in accurately detecting CCD, albeit this has been mostly investigated in cerebrovascular patients [ 3 , 9 ].…”

Cerebrovascular reactivity mapping without hypercapnic challenge in patients with carotid artery stenosis

“…Previous studies have evaluated different magnetic resonance imaging (MRI) protocols based on the blood oxygenation level-dependent contrast (BOLD) to assess CVR in combination with breathholding 4 , acetazolamide injection 5 or CO2 inhalation 6 . Others have explored the clinical potential of BOLD-MRI and vasoactive stimuli, and have shown its ability to differentiate between normal and impaired CVR in arterial stenosis 7 , stroke, small vessel disease 8 , neurovascular coupling in brain tumors 9 , hypertension 1 , Alzheimer's disease 10 , and epilepsy 11 . In patients whose clinical evaluation still leaves doubts about the correct diagnosis or best management, altered CVR may be a helpful image marker.…”