ORIGINAL ARTICLE   

Minerva Chirurgica 2019 August;74(4):313-9

DOI: 10.23736/S0026-4733.17.07453-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Intraoperative perfusion-weighted imaging in non-enhanced glioma surgery

Zhong-Jun CHEN ¹, Jin-Long ZHENG ², Wei GUAN ¹, Wen-Guang LIU ¹ ✉, Jin-Yu ZHENG ¹, Jian-Dong ZUO ¹

¹ Department of Neurosurgery, Huai’an Hospital Affiliated to Xuzhou Medical College and Second People’s Hospital, Huai’an, China; ² Department of Neurology, Huai’an First People’s Hospital, Nanjing Medical University, Huai’an, China

BACKGROUND: The objective of the present study was to observe and analyze the significance of perfusion-weighted imaging for guiding the operation implementation for non-enhanced glioma, and analyze the estimation of the histopathological grade of the non-enhanced glioma and the accuracy of the degree of malignancy degree before surgery.
METHODS: Fifty-six patients diagnosed with non-enhanced glioma through conventional magnetic resonance scanning were selected. Before surgery, conventional magnetic resonance scanning and perfusion-weighted imaging were performed on all patients. The property classification was performed with the perfusion-weighted imaging parameters: cerebral blood volume (CBV) and cerebral blood flow (CBF) before surgery.
RESULTS: Surgery was performed on the 56 patients. Tumors were excised and processed for histopathological classification and semi-quantitative immunohistochemical analysis of vascular endothelial growth factor (VEGF) levels. Histology was compared after surgery and the classification accuracy rate was analyzed before surgery. Additionally, conventional magnetic resonance scanning and perfusion-weighted imaging were performed on 15 patients during surgery. We compared and analyzed the reference value of perfusion-weighted imaging before and during surgery. Residual diseased tissues were excised; histopathological examination was performed, and semi-quantitative immunohistochemical analysis of VEGF was performed. Regarding maximal magnetic resonance perfusion-weighted imaging measured before surgery, the CBV, CBF, and expression level of VEGF were positively correlated with the pathological grade of tumors. If the CBV and CBF values of the non-enhanced glioma were higher, the grade of malignancy was higher (P<0.01), and the positive expression rate of VEGF was higher (P<0.01).
CONCLUSIONS: Magnetic resonance perfusion-weighted imaging can display vessel growth and distribution within non-enhanced gliomas before surgery, and effectively evaluate the histopathological grade and grade of malignancy, and provide accurate guidance for tumor resection during surgery.

KEY WORDS: Perfusion imaging; Glioma; Computer-assisted surgery