TY - JOUR AU - Heßelmann, Volker; Mager, Ann-Kathrin; Goetz, Claudia; Detsch, Oliver; Theisgen, Hannah-Katharina; Friese, Michael; Schwindt, Wolfram; Gottschalk, Joachim; Kremer, Paul TI - Accuracy of High-Field Intraoperative MRI in the Detectability of Residual Tumor in Glioma Grade IV Resections TT - Treffsicherheit der Intraoperativen MR-Bildgebung (ioMRI)in der Nachweisbarkeit von Resttumorgewebe zur Resektion hochgradiger (Grad IV) Gliome SN - 1438-9029 SN - 1438-9010 PY - 2017 JO - Rofo JF - RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren LA - DE VL - 189 IS - 06 SP - 519 EP - 526 DA - 2017/06/07 KW - intraoperative KW - treatment planning KW - gadolinium KW - aminolaevolinic acid KW - mr imaging KW - high-grade glioma AB - Objective To assess the sensitivity/specificity of tumor detection by T1 contrast enhancement in intraoperative MRI (ioMRI) in comparison to histopathological assessment as the gold standard in patients receiving surgical resection of grade IV glioblastoma.Materials and Methods 68 patients with a primary or a recurrent glioblastoma scheduled for surgery including fluorescence guidance and neuronavigation were included (mean age: 59 years, 26 female, 42 male patients). The ioMRI after the first resection included transverse FLAIR, DWI, T2-FFE and T1 – 3 d FFE +/- GD-DPTA. The second resection was performed whenever residual contrast-enhancing tissue was detected on ioMRI. Resected tissue samples were histopathologically evaluated (gold standard). Additionally, we evaluated the early postoperative MRI scan acquired within 48 h post-OP for remaining enhancing tissue and compared them with the ioMRI scan.Results In 43 patients ioMRI indicated residual tumorous tissue, which could be confirmed in the histological specimens of the second resection. In 16 (4 with recurrent, 12 with primary glioblastoma) cases, ioMRI revealed truly negative results without residual tumor and follow-up MRI confirmed complete resection. In 7 cases (3 with recurrent, 4 with primary glioblastoma) ioMRI revealed a suspicious result without tumorous tissue in the histopathological workup. In 2 (1 for each group) patients, residual tumorous tissue was detected in spite of negative ioMRI. IoMRI had a sensitivity of 95 % (94 % recurrent and 96 % for primary glioblastoma) and a specificity of 69.5 % (57 % and 75 %, respectively). The positive predictive value was 86 % (84 % for recurrent and 87 % for primary glioblastoma), and the negative predictive value was 88 % (80 % and 92 %, respectively).Conclusion ioMRI is effective for detecting remaining tumorous tissue after glioma resection. However, scars and leakage of contrast agent can be misleading and limit specificity.Key points Citation Format PB - © Georg Thieme Verlag KG DO - 10.1055/s-0043-106189 UR - http://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0043-106189 ER -