Report of Negative Diffusion-Weighted MR Imaging during Tumor Resections Using Intraoperative MRI

Prabhu, Sujit S.; Levine, Nicholas B.; Rao, Ganesh; Shah, Komal; Weinberg, Jeffrey S.

doi:10.1159/000230693

Cited by 4 publications

(5 citation statements)

References 37 publications

(20 reference statements)

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“…In the intraoperative setting, however, the occurrence of false-negative DWI imaging in ioMRI is clearly underreported and includes only reports of single cases 16 , 17 . Prabhu et al 17 presented three cases with false-negative DWI in ioMRI during tumor resection, although in one patient additional resection was performed after intraoperative resection control, and no information was provided about the other two cases regarding extended resection. In our current report we explicitly filtered cases where no further resection was performed after ioMRI in order to prevent accidental inclusion of new infarcts induced surgically after ioMRI.…”

Section: Discussionmentioning

confidence: 99%

“…Various possible explanations for the phenomenon of false-negative DWI findings have been postulated. A focal reduction in cerebral blood flow (CBF) below a threshold critical for neuronal function but still sufficient for proper diffusion was suggested 17 , 31 , 32 . Numerous studies have tried to determine the critical CBF threshold for survival of the penumbra in focal ischemia 31 , 33 .…”

Section: Discussionmentioning

confidence: 99%

“…However, little is known about the occurrence of false-negative DWI signals in the context of hyperacute stroke imaging, especially when acquired intraoperatively. The available literature regarding ioMRI with false-negative DWI is limited to a few case studies 16 , 17 , whereas in hyperacute stroke imaging false-negative DWI signals are much more frequently described 18 – 25 .…”

Section: Introductionmentioning

confidence: 99%

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

Voglis

Hiller

Hofer

et al. 2021

Sci Rep

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Intraoperatively acquired diffusion-weighted imaging (DWI) sequences in cranial tumor surgery are used for early detection of ischemic brain injuries, which could result in impaired neurological outcome and their presence might thus influence the neurosurgeon’s decision on further resection. The phenomenon of false-negative DWI findings in intraoperative magnetic resonance imaging (ioMRI) has only been reported in single cases and therefore yet needs to be further analyzed. This retrospective single-center study’s objective was the identification and characterization of false-negative DWI findings in ioMRI with new or enlarged ischemic areas on postoperative MRI (poMRI). Out of 225 cranial tumor surgeries with intraoperative DWI sequences, 16 cases with no additional resection after ioMRI and available in-time poMRI (< 14 days) were identified. Of these, a total of 12 cases showed false-negative DWI in ioMRI (75%). The most frequent tumor types were oligodendrogliomas and glioblastomas (4 each). In 5/12 cases (41.7%), an ischemic area was already present in ioMRI, however, volumetrically increased in poMRI (mean infarct growth + 2.1 cm3; 0.48–3.6), whereas 7 cases (58.3%) harbored totally new infarcts on poMRI (mean infarct volume 0.77 cm3; 0.05–1.93). With this study we provide the most comprehensive series of false-negative DWI findings in ioMRI that were not followed by additional resection. Our study underlines the limitations of intraoperative DWI sequences for the detection and size-estimation of hyperacute infarction. The awareness of this phenomenon is crucial for any neurosurgeon utilizing ioMRI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Voglis

Hiller

Hofer

et al. 2021

Sci Rep

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“…Although DWI images were previously described to reach a high sensitivity and specificity to detect ischemic brain lesions [5], falsenegative reports of DWI sequences are present. This phenomenon of false-negative or underestimated infarcts on MRI is not well described and poorly understood, especially in ioMRI [10,15,18] and also in hyperacute stroke imaging [8,[14][15][16]. Possible explanations might be that ioMRI occurs too early to detect hyperacute infarcts or that vasospasms contribute to delayed infarct development without further tissue manipulation by the surgeon.…”

Section: Discussionmentioning

confidence: 99%

Impact of additional resection on new ischemic lesions and their clinical relevance after intraoperative 3 Tesla MRI in neuro-oncological surgery

et al. 2020

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Intraoperative MRI (ioMRI) has become a frequently used tool to improve maximum safe resection in brain tumor surgery. The usability of intraoperatively acquired diffusion-weighted imaging sequences to predict the extent and clinical relevance of new infarcts has not yet been studied. Furthermore, the question of whether more aggressive surgery after ioMRI leads to more or larger infarcts is of crucial interest for the surgeons’ operative strategy. Retrospective single-center analysis of a prospective registry of procedures from 2013 to 2019 with ioMRI was used. Infarct volumes in ioMRI/poMRI, lesion localization, mRS, and NIHSS were analyzed for each case. A total of 177 individual operations (60% male, mean age 45.5 years old) met the inclusion criteria. In 61% of the procedures, additional resection was performed after ioMRI, which resulted in a significantly higher number of new ischemic lesions postoperatively (p < .001). The development of new or enlarged ischemic areas upon additional resection could also be shown volumetrically (mean volume in ioMRI 0.39 cm3 vs. poMRI 2.97 cm3; p < .001). Despite the surgically induced new infarcts, mRS and NIHSS did not worsen significantly in cases with additional resection. Additionally, new perilesional ischemia in eloquently located tumors was not associated with an impaired neurological outcome. Additional resection after ioMRI leads to new or enlarged ischemic areas. However, these new infarcts do not necessarily result in an impaired neurological outcome, even when in eloquent brain areas.

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“…The use of multimodal neuroradiologic imaging in combination with highly technologic analyses is useful for making neurosurgical procedures possible, especially in noncircumscribed brain tumors such as glioma (Wakabayashi et al, 2009). Diffusion-weighted imaging (DWI) is an essential diagnostic tool in the postoperative setting for the early detection of ischemic brain injury that could potentially result in infarction and development of neurologic deficits during surgical resection (Prabhu, Levine, Rao, Shah, & Weinberg, 2009). Several studies have shown that postoperative ischemic brain injury is common in glioma surgical resections and best detected by DWI showing diffusion restriction.…”

Section: J Adv Pract Oncolmentioning

confidence: 99%

Neurotoxicity Associated With Cancer Therapy

E¹,

Westcarth²

2012

JADPRO

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ancer therapy uses a combination of treatment modalities such as surgery, radiation, and chemotherapy that may improve patient prognosis (Van Meir, Bellail, & Phyphanich, 2004;Butowski & Chang, 2005). However, combination therapy and extended survival are often associated with potential acute or delayed toxicities, including neurotoxicities. Patients with tumors of the nervous system are at particular risk for these complications. Traumatic or ischemic injuries are manifestations of central nervous system (CNS) toxicity as a result of brain-directed surgery to treat primary brain tumor or metastatic disease (Chi, Behin, & Delattre, 2008). Neurotoxicity related to chemotherapy is a common complication and often constitutes a dose-limiting toxicity. As newer agents and targeted therapies are developed, the number and range of potential neurotoxicities also increases (Dropcho, 2010a). Exposure of the CNS to therapeutic radiation, whether direct or incidental, is a potential risk for symptomatic neurologic injury (Dropcho, 2010b). Familiarity with the common neurologic toxicities experienced by patients with CNS tumors will assist the advanced practitioner in oncology in timely assessment and effective therapeutic interventions for these patients. Central Nervous System SURGERYMaximum safe resection is the most important goal of surgery for malignant glioma (Chang et al., 2003). This provides histologic diagnosis, reduces neurologic symptoms, and prolongs survival. Complications associated with craniotomy can be classified as neurologic, regional, and systemic (Table 1). Neurologic complications can be a consequence of direct injury to normal brain structures, cerebral edema, vascular injury, or hematoma (Warnick & Petr, 2008; Figure 1). There is also a predisposition to acquire skin organisms and subsequent infection when patients undergo procedures causing

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Report of Negative Diffusion-Weighted MR Imaging during Tumor Resections Using Intraoperative MRI

Cited by 4 publications

References 37 publications

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

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

Impact of additional resection on new ischemic lesions and their clinical relevance after intraoperative 3 Tesla MRI in neuro-oncological surgery

Neurotoxicity Associated With Cancer Therapy

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