MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases
ObjectRecent studies demonstrated that gross total resection of brain metastases cannot always be achieved. Subtotal resection (STR) can result in an early recurrence and might affect patient survival. We initiated a prospective observational study to establish a MRI-based risk assessment for incomp...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.873175/full |
| _version_ | 1818206766184267776 |
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| author | Tizian Rosenstock Tizian Rosenstock Paul Pöser David Wasilewski Hans-Christian Bauknecht Ulrike Grittner Thomas Picht Thomas Picht Martin Misch Julia Sophie Onken Peter Vajkoczy |
| author_facet | Tizian Rosenstock Tizian Rosenstock Paul Pöser David Wasilewski Hans-Christian Bauknecht Ulrike Grittner Thomas Picht Thomas Picht Martin Misch Julia Sophie Onken Peter Vajkoczy |
| author_sort | Tizian Rosenstock |
| collection | DOAJ |
| description | ObjectRecent studies demonstrated that gross total resection of brain metastases cannot always be achieved. Subtotal resection (STR) can result in an early recurrence and might affect patient survival. We initiated a prospective observational study to establish a MRI-based risk assessment for incomplete resection of brain metastases.MethodsAll patients in whom ≥1 brain metastasis was resected were prospectively included in this study (DRKS ID: DRKS00021224; Nov 2020 – Nov 2021). An interdisciplinary board of neurosurgeons and neuroradiologists evaluated the pre- and postoperative MRI (≤48h after surgery) for residual tumor. Extensive neuroradiological analyses were performed to identify risk factors for an unintended STR which were integrated into a regression tree analysis to determine the patients’ individual risk for a STR.ResultsWe included 150 patients (74 female; mean age: 61 years), in whom 165 brain metastases were resected. A STR was detected in 32 cases (19.4%) (median residual tumor volume: 1.36ml, median EORrel: 93.6%), of which 6 (3.6%) were intended STR (median residual tumor volume: 3.27ml, median EORrel: 67.3%) - mainly due to motor-eloquent location - and 26 (15.8%) were unintended STR (uSTR) (median residual tumor volume: 0.64ml, median EORrel: 94.7%). The following risk factors for an uSTR could be identified: subcortical metastasis ≥5mm distant from cortex, diffuse contrast agent enhancement, proximity to the ventricles, contact to falx/tentorium and non-transcortical approaches. Regression tree analysis revealed that the individual risk for an uSTR was mainly associated to the distance from the cortex (distance ≥5mm vs. <5mm: OR 8.0; 95%CI: 2.7 – 24.4) and the contrast agent patterns (diffuse vs. non-diffuse in those with distance ≥5mm: OR: 4.2; 95%CI: 1.3 – 13.7). The preoperative tumor volume was not substantially associated with the extent of resection.ConclusionsSubcortical metastases ≥5mm distant from cortex with diffuse contrast agent enhancement showed the highest incidence of uSTR. The proposed MRI-based assessment allows estimation of the individual risk for uSTR and can help indicating intraoperative imaging. |
| first_indexed | 2024-12-12T04:18:14Z |
| format | Article |
| id | doaj.art-67a3771715254f97a19a7c3658e89dbd |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-12T04:18:14Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-67a3771715254f97a19a7c3658e89dbd2022-12-22T00:38:24ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-05-011210.3389/fonc.2022.873175873175MRI-Based Risk Assessment for Incomplete Resection of Brain MetastasesTizian Rosenstock0Tizian Rosenstock1Paul Pöser2David Wasilewski3Hans-Christian Bauknecht4Ulrike Grittner5Thomas Picht6Thomas Picht7Martin Misch8Julia Sophie Onken9Peter Vajkoczy10Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyBerlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Berlin, GermanyDepartment of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyDepartment of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyInstitute of Neuroradiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyInstitute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyDepartment of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyCluster of Excellence: “Matters of Activity. Image Space Material,” Humboldt University, Berlin, GermanyDepartment of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyDepartment of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyDepartment of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyObjectRecent studies demonstrated that gross total resection of brain metastases cannot always be achieved. Subtotal resection (STR) can result in an early recurrence and might affect patient survival. We initiated a prospective observational study to establish a MRI-based risk assessment for incomplete resection of brain metastases.MethodsAll patients in whom ≥1 brain metastasis was resected were prospectively included in this study (DRKS ID: DRKS00021224; Nov 2020 – Nov 2021). An interdisciplinary board of neurosurgeons and neuroradiologists evaluated the pre- and postoperative MRI (≤48h after surgery) for residual tumor. Extensive neuroradiological analyses were performed to identify risk factors for an unintended STR which were integrated into a regression tree analysis to determine the patients’ individual risk for a STR.ResultsWe included 150 patients (74 female; mean age: 61 years), in whom 165 brain metastases were resected. A STR was detected in 32 cases (19.4%) (median residual tumor volume: 1.36ml, median EORrel: 93.6%), of which 6 (3.6%) were intended STR (median residual tumor volume: 3.27ml, median EORrel: 67.3%) - mainly due to motor-eloquent location - and 26 (15.8%) were unintended STR (uSTR) (median residual tumor volume: 0.64ml, median EORrel: 94.7%). The following risk factors for an uSTR could be identified: subcortical metastasis ≥5mm distant from cortex, diffuse contrast agent enhancement, proximity to the ventricles, contact to falx/tentorium and non-transcortical approaches. Regression tree analysis revealed that the individual risk for an uSTR was mainly associated to the distance from the cortex (distance ≥5mm vs. <5mm: OR 8.0; 95%CI: 2.7 – 24.4) and the contrast agent patterns (diffuse vs. non-diffuse in those with distance ≥5mm: OR: 4.2; 95%CI: 1.3 – 13.7). The preoperative tumor volume was not substantially associated with the extent of resection.ConclusionsSubcortical metastases ≥5mm distant from cortex with diffuse contrast agent enhancement showed the highest incidence of uSTR. The proposed MRI-based assessment allows estimation of the individual risk for uSTR and can help indicating intraoperative imaging.https://www.frontiersin.org/articles/10.3389/fonc.2022.873175/fullbrain metastasismagnetic resonance imaging (MRI)neurosurgical resectionextent of resection(GTR) gross total resection(STR) subtotal resection |
| spellingShingle | Tizian Rosenstock Tizian Rosenstock Paul Pöser David Wasilewski Hans-Christian Bauknecht Ulrike Grittner Thomas Picht Thomas Picht Martin Misch Julia Sophie Onken Peter Vajkoczy MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases Frontiers in Oncology brain metastasis magnetic resonance imaging (MRI) neurosurgical resection extent of resection (GTR) gross total resection (STR) subtotal resection |
| title | MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases |
| title_full | MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases |
| title_fullStr | MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases |
| title_full_unstemmed | MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases |
| title_short | MRI-Based Risk Assessment for Incomplete Resection of Brain Metastases |
| title_sort | mri based risk assessment for incomplete resection of brain metastases |
| topic | brain metastasis magnetic resonance imaging (MRI) neurosurgical resection extent of resection (GTR) gross total resection (STR) subtotal resection |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.873175/full |
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