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Failure of diffusion-weighted imaging in intraoperative 3 Tesla MRI to identify hyperacute strokes during glioma
Stefanos Voglis1, Aimee Hiller2, Anna-Sophie Hofer2
1Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. stefanos.voglis@usz.ch.
Abstract:
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.
Insights
Intraoperative diffusion-weighted imaging (DWI) in brain tumor surgery can miss new or growing ischemic injuries, potentially impacting surgical decisions. This study highlights the limitations of DWI in detecting hyperacute infarcts during surgery.
Area of Science:
- Neurosurgery
- Neuroradiology
- Neuroscience
Background:
- Intraoperative diffusion-weighted imaging (DWI) is crucial for detecting ischemic brain injuries during cranial tumor surgery, influencing neurosurgical decisions on resection.
- False-negative DWI findings in intraoperative magnetic resonance imaging (ioMRI) are rare but can lead to underestimation of neurological injury.
- This study aimed to identify and characterize false-negative DWI findings in ioMRI for new or enlarged ischemic areas.
Observation:
- A retrospective analysis of 225 cranial tumor surgeries with intraoperative DWI was conducted.
- 16 cases without additional resection after ioMRI and with early postoperative MRI (poMRI) were identified.
- 12 of these cases (75%) demonstrated false-negative DWI findings in ioMRI.
Findings:
- False-negative DWI findings were most common in oligodendrogliomas and glioblastomas.
- In 41.7% of false-negative cases, infarcts were present but increased in volume on poMRI (mean growth +2.1 cm³).
- In 58.3% of false-negative cases, new infarcts were detected on poMRI (mean volume 0.77 cm³).
Implications:
- Intraoperative DWI has limitations in detecting and estimating the size of hyperacute infarcts.
- Awareness of false-negative DWI findings is critical for neurosurgeons using ioMRI.
- This comprehensive series underscores the need for careful interpretation of ioMRI in cranial tumor surgery.
