TY - JOUR
T1 - Preoperative imaging to predict intraoperative changes in tumor-to-corticospinal tract distance
T2 - An analysis of 45 cases using high-field intraoperative magnetic resonance imaging
AU - Shahar, Tal
AU - Rozovski, Uri
AU - Marko, Nicholas F.
AU - Tummala, Sudhakar
AU - Ziu, Mateo
AU - Weinberg, Jeffrey S.
AU - Rao, Ganesh
AU - Kumar, Vinodh A.
AU - Sawaya, Raymond
AU - Prabhu, Sujit S.
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/7
Y1 - 2014/7
N2 - BACKGROUND: Preoperative diffusion tensor imaging (DTI) is used to demonstrate corticospinal tract (CST) position. Intraoperative brain shifts may limit preoperative DTI value, and studies characterizing such shifts are lacking. OBJECTIVE: To examine tumor characteristics that could predict intraoperative shift in tumor-to-CST distance using high-field intraoperative magnetic resonance imaging. METHODS: We retrospectively evaluated preoperative and intraoperative DTIs, tumor pathology, and imaging characteristics of patients who underwent resection of an intra-axial tumor adjacent to the CST to identify covariates that significantly affected shift in tumor-to-CST distance. For validation, we analyzed data from a separate, 20-patient cohort. RESULTS: In the first cohort, the mean intraoperative shift in the tumor-to-CST distance was 3.18 ± 3.58 mm. The mean shift for the 20 patients with contrast and the 5 patients with non-contrast-enhancing tumors was 3.93 ± 3.64 and 0.18 ± 0.18 mm, respectively (P <.001). No association was found between intraoperative shift in tumor-to-CST distance and tumor pathology, tumor volume, edema volume, preoperative tumor-to-CST distance, or extent of resection. According to receiver-operating characteristic analysis, nonenhancement predicted a tumor-to-CST distance shift of ≤0.5 mm, with a sensitivity of 100% and a specificity of 75%. We validated these findings using the second cohort. CONCLUSION: For nonenhancing intra-axial tumors, preoperative DTI is a reliable method for assessing intraoperative tumor-to-CST distance because of minimal intraoperative shift, a finding that is important in the interpretation of subcortical motor evoked potential to maximize extent of resection and to preserve motor function. In resection of intra-axial enhancing tumors, intraoperative imaging studies are crucial to compensate for brain shift.
AB - BACKGROUND: Preoperative diffusion tensor imaging (DTI) is used to demonstrate corticospinal tract (CST) position. Intraoperative brain shifts may limit preoperative DTI value, and studies characterizing such shifts are lacking. OBJECTIVE: To examine tumor characteristics that could predict intraoperative shift in tumor-to-CST distance using high-field intraoperative magnetic resonance imaging. METHODS: We retrospectively evaluated preoperative and intraoperative DTIs, tumor pathology, and imaging characteristics of patients who underwent resection of an intra-axial tumor adjacent to the CST to identify covariates that significantly affected shift in tumor-to-CST distance. For validation, we analyzed data from a separate, 20-patient cohort. RESULTS: In the first cohort, the mean intraoperative shift in the tumor-to-CST distance was 3.18 ± 3.58 mm. The mean shift for the 20 patients with contrast and the 5 patients with non-contrast-enhancing tumors was 3.93 ± 3.64 and 0.18 ± 0.18 mm, respectively (P <.001). No association was found between intraoperative shift in tumor-to-CST distance and tumor pathology, tumor volume, edema volume, preoperative tumor-to-CST distance, or extent of resection. According to receiver-operating characteristic analysis, nonenhancement predicted a tumor-to-CST distance shift of ≤0.5 mm, with a sensitivity of 100% and a specificity of 75%. We validated these findings using the second cohort. CONCLUSION: For nonenhancing intra-axial tumors, preoperative DTI is a reliable method for assessing intraoperative tumor-to-CST distance because of minimal intraoperative shift, a finding that is important in the interpretation of subcortical motor evoked potential to maximize extent of resection and to preserve motor function. In resection of intra-axial enhancing tumors, intraoperative imaging studies are crucial to compensate for brain shift.
KW - Brain shift
KW - Diffusion tensor imaging
KW - Glioma
KW - High-field intraoperative magnetic resonance imaging
KW - Subcortical motor evoked potential
KW - Tumor-to-CST distance
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U2 - 10.1227/NEU.0000000000000338
DO - 10.1227/NEU.0000000000000338
M3 - Review article
C2 - 24618800
AN - SCOPUS:84902785747
SN - 0148-396X
VL - 75
SP - 23
EP - 30
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -