The determination of the boundaries and prediction the radicality of glioblastoma resection using MRI and CT perfusion.

Abstract

Background: Preoperative identification of diffuse glioma boundaries remains an unsolved problem of modern neurooncology. The main problem is the heterogeneity of the tumor being manifested by simultaneous presence of both contrast-enhancing and non-contrasting but hyperperfused regions on imaging. Perfusion technologies are known to be a reliable tool in identifying areas with intact BBB and increased proliferative activity of vascular endothelium.

Aim: The purpose of this study is to evaluate the impact of MRI and CT perfusion data in preoperative planning of surgical resection in order to achieve the maximum volume of cytoreduction and to prolong relapse-free period.

Methods: The study included 74 patients with the morphologically and immunohistochemically verified diagnosis of "glioblastoma NOS." The patients were divided into 2 groups depending on the perfusion data and the extent of tumor resection. Group 1 of patients had a surgery with the preoperative use of perfusion techniques and the resection of the contrast-enhancing and hyperperfused portion of the tumor (n = 42), group 2 of patients had a surgery with preoperative use of perfusion techniques and resection of only the contrast-enhancing component of the tumor (n = 32).

Results: The results of the study show that the surgery directed to the resection of contrast-positive and hyperperfused tumor portions has an advantage when compared with surgery aimed at removing only the contrast-enhancing part of the tumor. In group 1, the median relapse-free period was 15 months, while the relapse-free survival in 6 and 12 months was 92 and 55% which exceeded the results in the second group, in which the median was 9 months, and the relapse-free survival in 6 and 12 months was 66 and 9% (p < 0.001).

Conclusion: Our study shows that the use of perfusion techniques in preoperative planning of the resection volume has a favorable potential and high diagnostic value. Perfusion tools may be contribute to the most objective assessment of all tumor components. The prolongation of the relapse-free period was achieved by taking into account the factor as the resection of both the contrast-enhanced component and the contrast-negative component with high vascular permeability detected by perfusion techniques.