Preoperative MR Perfusion and Intraoperative MR Imaging in Predicting Surgical Resectability and Quality of Life...

Introduction The successful treatment of high-grade gliomas (HGGs) relies on advanced magnetic resonance (MR) imaging technologies to increase the resection of active tumor areas and impact patient quality of life (QoL) and overall survival (OS). The objective of this prospective pilot study was to evaluate whether preoperative MR perfusion parameters (cerebral blood volume (CBV), cerebral blood flow (CBF)) and intraoperative MRI (iMRI) can predict extent of resection (EOR), OS and progression-free survival (PFS), and postoperative QoL, with a secondary aim of determining whether QoL measures provide prognostic information earlier than conventional neurological or performance status assessments. Methods A prospective, single-center study of HGG patients, including grade 3 astrocytoma and glioblastoma, who underwent surgery guided by advanced MRI, was performed. Preoperative CBV, preoperative CBF, and EOR were compared with patient complications and QoL metrics via the MD Anderson Symptom Inventory and Functional Assessment of Cancer Therapy-Brain questionnaires. Patients were divided into good versus poor outcomes by median OS (10 months). Results Fourteen patients (mean age: 52.2, 35.7% male), including three isocitrate dehydrogenase 1/2 (IDH1/2) mutant and 11 IDH1/2 wild-type cases, were studied. For patients with good outcomes, OS and PFS were 27 ± 15 months (p = 0.002) and 21 ± 20 months (p = 0.05), respectively. Higher preoperative CBV and CBF were associated with worse OS (p < 0.05). iMRI perfusion was difficult to quantify and limited in correlating with patient outcomes. The mean EOR was 96 ± 5% during iMRIs, and no EOR difference was observed between patients with good or poor survival. Patients with worse OS and PFS showed a significant decline in three-month QoL metrics, especially in social/family well-being domains that preceded changes in Karnofsky Performance Status. Conclusion Advanced MRI and quantitative QoL measurements may help predict long-term survival for HGG patients but require further exploration and analysis.