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Updated: Aug 9, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
T1-Weighted Contrast Enhancement, Apparent Diffusion Coefficient, and Cerebral-Blood-Volume Changes after
Davide Negroni1, Romina Bono1, Eleonora Soligo2
1Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy.
Background:
The aim of the study is to identify the advantages, if any, of post-operative MRIs performed at 48 h compared to MRIs performed after 48 h in glioblastoma surgery.
Materials And Methods:
To assess the presence of a residual tumor, the T1-weighted Contrast Enhancement (CE), Apparent Diffusion Coefficient (ADC), and Cerebral Blood Volume (rCBV) in the proximity of the surgical cavity were considered. The rCBV ratio was calculated by comparing the rCBV with the contralateral normal white matter. After the blind image examinations by the two radiologists, the patients were divided into two groups according to time window after surgery: ≤48 h (group 1) and >48 h (group 2).
Results:
A total of 145 patients were enrolled; at the 6-month follow-up MRI, disease recurrence was 89.9% (125/139), with a mean patient survival of 8.5 months (SD 7.8). The mean ADC and rCBV ratio values presented statistical differences between the two groups (p < 0.05). Of these 40 patients in whom an ADC value was not obtained, the rCBV values could not be calculated in 52.5% (21/40) due to artifacts (p < 0.05).
Conclusion:
The study showed differences in CE, rCBV, and ADC values between the groups of patients undergoing MRIs before and after 48 h. An MRI performed within 48 h may increase the ability of detecting GBM by the perfusion technique with the calculation of the rCBV ratio.
Insights
Post-operative MRIs for glioblastoma surgery within 48 hours show distinct differences in tumor characteristics. Early imaging may improve detection of residual glioblastoma using perfusion techniques and calculating the relative Cerebral Blood Volume ratio.
Area of Science:
- Neuro-oncology
- Radiology
- Medical Imaging
Background:
- Glioblastoma multiforme (GBM) surgery requires accurate assessment of residual tumor.
- Post-operative MRI timing is crucial for evaluating treatment effectiveness.
- Standard imaging protocols may not fully capture early post-surgical changes.
Purpose of the Study:
- To compare the diagnostic utility of post-operative MRIs performed within 48 hours versus after 48 hours in glioblastoma patients.
- To identify advantages of early post-operative MRI in glioblastoma assessment.
- To evaluate specific MRI parameters for residual tumor detection.
Main Methods:
- 145 glioblastoma patients underwent post-operative MRI.
- T1-weighted Contrast Enhancement (CE), Apparent Diffusion Coefficient (ADC), and Cerebral Blood Volume (rCBV) were analyzed.
- Patients were grouped into early (≤48 h) and late (>48 h) post-operative MRI groups.
Main Results:
- Significant differences in ADC and rCBV ratio values were observed between the early and late imaging groups (p < 0.05).
- Early post-operative MRI (≤48 h) demonstrated potential advantages in detecting glioblastoma.
- Artifacts impacted rCBV calculation in a subset of patients, highlighting the importance of imaging quality.
Conclusions:
- MRI findings, including CE, rCBV, and ADC values, differ based on post-operative timing.
- Performing MRI within 48 hours post-surgery may enhance glioblastoma detection using perfusion imaging.
- The rCBV ratio calculation shows promise for early residual tumor assessment in glioblastoma.
