Intraoperative MR Imaging Increases the Extent of Tumor Resection in Patients with High-Grade Gliomas
Michael Knauth
,a,
Christian R. Wirtza,
Volker M. Tronniera,
Nurdagül Arasa,
Stefan Kunzea and
Klaus Sartora
a From the Departments of Neuroradiology (M.K., N.A., K.S.) and Neurosurgery (C.R.W., V.M.T., S.K.), University of Heidelberg Medical School, Heidelberg, Germany.
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FIG 1. Surgically induced enhancement in the "uncertain" case of a 45-year-old man with a glioblastoma multiforme. The tumor is above the level of these T1-weighted images.
Left, Preoperative MR image (674/20/2) does not show enhancement in the head of the right caudate nucleus. Problems with hemostasis necessitated repeated electrocoagulations in this region.
Middle, Intraoperative MR image (532/15/3) shows partially solid-appearing contrast enhancement of the head of the caudate nucleus. A small biopsy was obtained from this region and did not show residual tumor histologically. Surgery was terminated.
Right, Early postoperative MR image (674/20/2) does not show persistent enhancement of the head of the caudate nucleus. The intraoperative enhancement probably represented transient blood-brain barrier disruption.
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FIG 2. A 41-year-old woman with a recurrent glioblastoma multiforme.
Left, Preoperative T1-weighted image shows a left-hemispheric lesion (674/20/2).
Middle, Intraoperative MR image (532/15/3) shows residual enhancing tumor (arrowhead).
Right, Surgery was continued, and the residual tumor was removed, as shown in this early postoperative MR image (674/20/2).
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FIG 3. A 55-year-old man with a glioblastoma multiforme. The bulk of the tumor is above the level of these T1-weighted images.
Left, Preoperative MR image shows a right-hemispheric lesion (674/20/2).
Middle, Intraoperative MR image (532/15/3) shows residual tumor at the bottom of the resection cavity (arrowhead).
Right, Surgery was continued, and this residual tumor was removed, as shown in this early postoperative MR image (674/20/2).
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FIG 4. "Failure" of the intraoperative MR imaging approach in a 46-year-old man with an anaplastic glioma.
Left, Preoperative MR image shows a right-hemispheric lesion (674/20/2).
Middle, Intraoperative MR image (532/15/3) shows massive residual tumor. Surgery was continued with extensive further tumor resection.
Right, Early postoperative MR image (674/20/2), however, still shows residual enhancing tumor (arrowheads).
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