Related Experiment Video
Updated: May 13, 2025
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Cerebral flow estimated from 3D pCASL for prediction of intraoperative blood loss in non-embolized meningiomas: a
Xinru Deng1,2, Lianjiang Lv3, Dan Luo1,2
1Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Background:
Intraoperative hemorrhage in meningioma surgery represents a critical clinical challenge. In this study, we aimed to investigate the feasibility of predicting intraoperative blood loss (IBL) in non-embolized meningiomas using the cerebral blood flow (CBF) information estimated from three-dimensional (3D) pseudo-continuous arterial spin labeling (pCASL) magnetic resonance imaging (MRI).
Methods:
A total of 48 non-embolized meningioma patients who underwent preoperative 3D pCASL from September 2017 to July 2024 were retrospectively studied. IBL was recorded during the operation. The meningioma's CBF was normalized to the contralateral normal gray matter's CBF, yielding the normalized CBF, which was analyzed, along with MRI-based tumor anatomy including volume, the volume ratio between tumor and total brain (VRTB), maximum tumor diameter, and location. Patients were divided into high and low blood loss groups at a 400 mL threshold. Logistic regression was employed to find the parameters correlated with IBL. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis [area under the curve (AUC)] and the Delong test.
Results:
Clinical and radiological analysis revealed significant differences in tumor volume, VRTB, maximum tumor diameter, and normalized CBF between subgroups. Multivariate logistic regression identified VRTB [odds ratio (OR) =2.055, 95% confidence interval (CI): 1.250-3.379], and normalized CBF (OR =1.428, 95% CI: 1.109-1.838) as significant predictors of elevated IBL. Optimal cutoff values were 3.293% for VRTB and 1.817 for normalized CBF. The AUCs were 0.751 for VRTB and 0.683 for normalized CBF, with no significant difference between them (Delong test, P=0.582). The combined risk factors' AUC, including both VRTB and normalized CBF, was 0.867, showing a significant difference from normalized CBF (P=0.010) but not from VRTB (P=0.099).
Conclusions:
The normalized CBF and VRTB may serve as promising non-invasive imaging biomarkers to predict IBL and guide meningioma surgery.
