Surgically Induced Contrast Enhancements on Intraoperative and Early Postoperative MRI Following High-Grade Glioma Surgery: A Systematic Review

Alexander Malcolm Rykkje,Adam Espe Hansen,Jane Skjøth-Rasmussen,Dana Li,Jonathan Frederik Carlsen,Michael Bachmann Nielsen,Vibeke Andrée Larsen

doi:10.3390/diagnostics11081344

Alexander Malcolm Rykkje, Adam Espe Hansen + Show 5 more

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https://doi.org/10.3390/diagnostics11081344

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Abstract

For the radiological assessment of resection of high-grade gliomas, a 72-h diagnostic window is recommended to limit surgically induced contrast enhancements. However, such enhancements may occur earlier than 72 h post-surgery. This systematic review aimed to assess the evidence on the timing of the postsurgical MRI. PubMed, Embase, Web of Science and Cochrane were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles describing surgically induced contrast enhancements on MRI after resection for high-grade gliomas were included and analysed. The frequency of different contrast enhancement patterns on intraoperative MRI (iMRI) and early postoperative MRI (epMRI) was recorded. The search resulted in 1443 studies after removing duplicates, and a total of 12 studies were chosen for final review. Surgically induced contrast enhancements were reported at all time points after surgery, including on iMRI, but their type and frequency vary. Thin linear contrast enhancements were commonly found to be surgically induced and were less frequently recorded on postoperative days 1 and 2. This suggests that the optimal time to scan may be at or before this time. However, the evidence is limited, and higher-quality studies using larger and consecutively sampled populations are needed.

Highlights

High-grade gliomas are the most common malignant brain tumours in adults and are generally difficult to treat and have a poor prognosis [1,2]
Our research question was as follows: In patients operated for high-grade glioma, which magnetic resonance imaging (MRI) examination time point is most efficient for differentiating surgically induced contrast enhancements from a residual tumour? The time points include intraoperative MRI, and special attention is given to the evidence for the conventional 72-h diagnostic window
Miskin et al and Masuda et al reported data on intraoperative MRI (iMRI) compared with early postoperative MRI (epMRI) and recorded surgically induced contrast enhancements as new enhancements without specifying their morphology [21,28]

Summary

Introduction

High-grade gliomas are the most common malignant brain tumours in adults and are generally difficult to treat and have a poor prognosis [1,2]. Survival is correlated with the extent of surgical resection, which is usually evaluated on magnetic resonance imaging (MRI) soon after surgery [3,4]. Such an assessment is often difficult to make as both the surgical procedure and residual tumour tissue can cause contrast enhancements on MRI [5]. The recommendation is to perform the early postoperative MRI (epMRI) within 72 h after surgery [9,10] The evidence for this diagnostic window is based on only a handful of studies from the 1990s [11,12,13,14]. The optimal window for scanning high-grade gliomas is still debatable, especially in an era with increased use of iMRI, and in a time where surgery of high-grade gliomas is performed more and more frequently [23]

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