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Using Histopathology to Assess the Reliability of Intraoperative Magnetic Resonance Imaging in Guiding Additional
Amar S Shah1, Alexander T Yahanda1, Peter T Sylvester1
1Washington University School of Medicine, St. Louis, Missouri.
Background:
Intraoperative magnetic resonance imaging (iMRI) is a powerful tool for guiding brain tumor resections, provided that it accurately discerns residual tumor.
Objective:
To use histopathology to assess how reliably iMRI may discern additional tumor for a variety of tumor types, independent of the indications for iMRI.
Methods:
A multicenter database was used to calculate the odds of additional resection during the same surgical session for grade I to IV gliomas and pituitary adenomas. The reliability of iMRI for identifying residual tumor was assessed using histopathology of tissue resected after iMRI.
Results:
Gliomas (904/1517 cases, 59.6%) were more likely than pituitary adenomas (176/515, 34.2%) to receive additional resection after iMRI (P < .001), but these tumors were equally likely to have additional tissue sent for histopathology (398/904, 44.4% vs 66/176, 37.5%; P = .11). Tissue samples were available for resections after iMRI for 464 cases, with 415 (89.4%) positive for tumor. Additional resections after iMRI for gliomas (361/398, 90.7%) were more likely to yield additional tumor compared to pituitary adenomas (54/66, 81.8%) (P = .03). There were no significant differences in resection after iMRI yielding histopathologically positive tumor between grade I (58/65 cases, 89.2%; referent), grade II (82/92, 89.1%) (P = .98), grade III (72/81, 88.9%) (P = .95), or grade IV gliomas (149/160, 93.1%) (P = .33). Additional resection for previously resected tumors (122/135 cases, 90.4%) was equally likely to yield histopathologically confirmed tumor compared to newly-diagnosed tumors (293/329, 89.0%) (P = .83).
Conclusion:
Histopathological analysis of tissue resected after use of iMRI for grade I to IV gliomas and pituitary adenomas demonstrates that iMRI is highly reliable for identifying residual tumor.
Insights
Intraoperative MRI (iMRI) reliably identifies residual brain tumors. Histopathology confirms iMRI’s high accuracy in detecting additional tumor tissue during glioma and pituitary adenoma resections.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Intraoperative magnetic resonance imaging (iMRI) is crucial for guiding brain tumor resections.
- Accurate discernment of residual tumor by iMRI is essential for successful surgical outcomes.
Purpose of the Study:
- To evaluate the reliability of iMRI in detecting residual tumor tissue across various brain tumor types using histopathology.
- To assess iMRI's efficacy independent of the specific indications for its use during surgery.
Main Methods:
- A multicenter database was utilized to analyze the likelihood of additional resection post-iMRI.
- Histopathology of resected tissue after iMRI was employed to confirm the presence of residual tumor.
- The study included gliomas (grades I-IV) and pituitary adenomas.
Main Results:
- Gliomas showed a higher likelihood of additional resection after iMRI compared to pituitary adenomas.
- Histopathological analysis confirmed tumor in 89.4% of resected samples post-iMRI.
- iMRI demonstrated high reliability in identifying residual tumor across all glioma grades and in pituitary adenomas, with no significant differences observed based on tumor grade or prior resection status.
Conclusions:
- Histopathological analysis confirms that iMRI is highly reliable for identifying residual tumor during resections of gliomas and pituitary adenomas.
- iMRI serves as a dependable tool for neurosurgeons to ensure maximal safe tumor removal.
