Evaluation of the Role of Intraoperative Physiologic Mri in Differentiating Surgically Induced Contrast Enhancement from Residual Enhancing Tumor

High‐grade gliomas are the most common brain tumors in adults. The mean survival is about 14 months for glioblastomas (WHO grade IV) and 41 months for anaplastic astrocytoma (WHO grade III). It has been demonstrated that greater extent of resection is significantly associated with better survival. Therefore, maximum extent of resection should be the surgical goal in glioblastoma surgery while preserving neurological function. High‐field (≥1.5T) intraoperative MRI scanners provide highest resolution and excellent soft tissue contrast for detection of even small tumor remnants and have thus proven to be a sufficient tool providing extended tumor volume resections and higher percentages of gross total resectionsin glioma surgery.Currently, the presence of intraoperative residual tumors is primarily determined by contrast‐enhanced MRI. However, the residual enhancing tumor can be confused with surgically induced contrast enhancement, which is thought to be related to blood‐brain barrier disruption that present along surgical margin. In this 3‐year prospective study, we will evaluate the role of physiologic MRI in differentiating intraoperative residual tumors from surgically induced contrast enhancement. Physiologic MRI includes diffusion tensor imaging for mapping of water molecular diffusion, dynamic susceptibility contrast‐enhanced perfusion‐weighted imaging for evaluating neovascularity and angiogenesis, dynamic contrast‐enhanced perfusion‐weighted imaging for characterizing vascular permeability, susceptibility‐weighted imaging for detecting local magnetic field change, and MR spectroscopy quantifying cellular turnover and neuronal destruction. We aim to: 1) study if residual enhancing tumors can be differentiated from surgically induced contrast enhancement with DTI, DCE‐PWI, DSC‐PWI, SWI and MRS intraoperatively, 2) compare the diagnostic performance of physiologic MR imaging techniques that can differentiate between residual enhancing tumors and surgically induced contrast enhancement and 3) obtain evolutionary changes of surgically induced contrast enhancement on DTI, DCE‐PWI, DSC‐PWI, SWI and MRS.

Project ID:PC10108-1095
External Project ID:NSC101-2314-B182-084