Related Experiment Video
Updated: Jul 21, 2026
Modeling Brain Metastases Through Intracranial Injection and Magnetic Resonance Imaging
Published on: June 7, 2020
Comparing Utility of Intraoperative Magnetic Resonance Imaging and 5-Aminolevulinic Acid in High-Grade Glioma
Nova Kristine de Los Reyes-Nabhan1,2, Siddharth Sinha1, Imran Noorani1,3
1Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Background And Objectives:
High-grade glioma has a poor prognosis despite advancements in histopathological classifications and treatments. Various intraoperative modalities are used to maximize extent of resection (EoR) and intraoperative detection of residual tumor, including 5-aminolevulinic acid (5-ALA) and intraoperative MRI (iMRI). We conducted a systematic review with meta-analysis investigating the efficacy of iMRI vs 5-ALA in maximizing EoR and improving survival outcomes.
Methods:
A systematic review with meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, Scopus, and ClinicalTrials.gov databases, identifying randomized clinical trials (RCTs) and prospective studies comparing the use of 5-ALA and iMRI in high-grade glioma resection. The primary end points were EoR and survival outcomes. Quality assessment was conducted using the ROBINS-I risk of bias assessment and Jadad scale. Meta-analysis was performed using gross total resection rates, tumor detection sensitivity, and specificity.
Results:
Five RCTs and 5 prospective studies were identified. Five RCTs lacked published data, thus only 5 prospective studies were included in the data extraction. Combined 5-ALA with iMRI (100%) was superior to 5-ALA alone (61.7%; P < .002) in maximizing EoR. Gross total resection did not differ significantly between 5-ALA alone (78%) and iMRI alone (81%; P = .79). One study showed that specificity was higher with iMRI alone (0.70) than with 5-ALA alone (0.43; P < .001); however, this was not replicated by 2 other studies (iMRI vs 5-ALA: 0.60 vs 0.80, P < .001; 1.00 vs 1.00, P not significant). Two studies reported sensitivity; only 1 found lower sensitivity with iMRI vs 5-ALA with a significant difference (iMRI vs 5-ALA: 0.66 vs 0.90, P < .001).
Conclusion:
There is no clear evidence to suggest iMRI is superior to 5-ALA in maximizing EoR and improving survival. However, combined use of 5-ALA and iMRI may be more effective compared with either modality alone. Larger RCTs are needed to confirm any differences in efficacy between the 2 modalities.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...