Surgically Acquired Deficits and Diffusion Weighted MRI Changes after Glioma Resection - A Matched Case-Control Study with Blinded Neuroradiological AssessmentReportar como inadecuado




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Background

Acquired deficits following glioma resection may not only occur due to accidental resection of normal brain tissue. The possible importance of ischemic injuries in causing neurological deficits after brain tumor surgery is not much studied. We aimed to study the volume and frequency of early postoperative circulatory changes i.e. infarctions detected by diffusion weighted resonance imaging DWI in patients with surgically acquired neurological deficits compared to controls.

Methods

We designed a 1∶1 matched case-control study in patients with diffuse gliomas WHO grade II–IV operated with 3D ultrasound guided resection. 42 consecutive patients with acquired postoperative dysphasia and-or new motor deficits were compared to 42 matched controls without acquired deficits. Controls were matched with respect to histopathology, preoperative tumor volumes, and eloquence of location. Two independent radiologists blinded for clinical status assessed the postoperative DWI findings.

Results

Postoperative peri-tumoral infarctions were more often seen in patients with acquired deficits 63% versus 41%, p = 0.046 and volumes of DWI abnormalities were larger in cases than in controls with median 1.08 cm3 IQR 0–2.39 versus median 0 cm3 IQR 0–1.67, p = 0.047. Inter-rater agreement was substantial 67-82, κ = 0.64, p<0.001 for diagnosing radiological significant DWI abnormalities.

Conclusion

Peri-tumoral infarctions were more common and were larger in patients with acquired deficits after glioma surgery compared to glioma patients without deficits when assessed by early postoperative DWI. Infarctions may be a frequent and underestimated cause of acquired deficits after glioma resection. DWI changes may be an attractive endpoint in brain tumor surgery with both good inter-rater reliability among radiologists and clinical relevance.



Autor: Asgeir S. Jakola , Erik M. Berntsen, Pål Christensen, Sasha Gulati, Geirmund Unsgård, Kjell A. Kvistad, Ole Solheim

Fuente: http://plos.srce.hr/



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