Value of Early Postoperative FLAIR Volume Dynamic in Glioma with No or Minimal Enhancement

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• 作者：Stefanie Bette¹ ; ^{stefanie.bette@tum.de" class="auth_mail" title="E-mail the corresponding author} ; Johannes Kaesmacher¹ ; Thomas Huber¹ ; Claire Delbridge² ; Florian Ringel³ ; Tobias Boeckh-Behrens¹ ; Bernhard Meyer³ ; Claus Zimmer¹ ; Jan S. Kirschke¹ ; Jens Gempt³
• 关键词：Early postoperative MRI ; Low-grade glioma ; No enhancement
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：91
• 期：Complete
• 页码：548-559.e1
• 全文大小：1899 K

文摘

The evaluation of postoperative magnetic resonance imaging (MRI) in glioma with no or minimal enhancement is controversial because the evaluation of residual tumor volume can be biased. The purpose of this study was to clarify the value of early postoperative and 3-month MRI regarding its validity in predicting recurrent disease.

Methods

For this retrospective, single-center study, overall fluid attenuated inversion recovery (FLAIR) volumes (early postoperative [<48 hours] and 3-month MRI including FLAIR and T1-weighted sequences with and without contrast agent) of 99 patients were assessed using manual segmentation. FLAIR volume dynamic over the first 3 months after surgery and its effect on disease recurrence were evaluated while considering histopathologic features.

Results

Overall FLAIR-hyperintense volume significantly decreased between early postoperative and 3-month follow-up MRIs (P < 0.001). Early FLAIR volume increase had a high positive predictive value for overall disease recurrence after resection (85.71% [95%-CI: 62.64–96.24]). Early FLAIR volume dynamic (P < 0.001), isocitrate dehydrogenase 1/2 status (P = 0.002), and preoperative Karnofsky Performance Status (P = 0.012) were observed as independent factors for progression-free survival in multivariate analysis.

Conclusion

Early postoperative FLAIR volume assessment in gliomas with no or minimal enhancement is susceptible to a systematic overestimation of residual tumors. Nevertheless, early FLAIR volume dynamic is an independent factor for tumor recurrence that should be evaluated in order timely adapt surveillance and therapy regimens accordingly.