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World J Radiol. Aug 28, 2014; 6(8): 538-543
Published online Aug 28, 2014. doi: 10.4329/wjr.v6.i8.538
Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures
Stephan Ulmer
Stephan Ulmer, Neuroradiology, Medical Radiological Institute, 8001 Zurich, Switzerland
Stephan Ulmer, Institute of Neuroradiology, Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, 24105 Kiel, Germany
Author contributions: Ulmer S reviewed the literature, analyzed own data, created all figures, wrote the paper and performed all corrections in the revision.
Correspondence to: Stephan Ulmer, MD, Neuroradiology, Medical Radiological Institute, Bahnhofplatz 3, 8001 Zurich, Switzerland. ulmer@email.com
Telephone: +41-44-2252090 Fax: +41-44-2118754
Received: January 16, 2014
Revised: April 17, 2014
Accepted: June 18, 2014
Published online: August 28, 2014
Processing time: 224 Days and 15.6 Hours
Abstract

The goal in brain tumor surgery is to remove the maximum achievable amount of the tumor, preventing damage to “eloquent” brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been introduced, including an operating microscope in the late 1950s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resection cavity and thus overcome this remaining uncertainty of intraoperative MRI in high grade brain tumor resection.

Keywords: Intraoperative magnetic resonance imaging; Dynamic susceptibility contrast magnetic resonance imaging; Dynamic contrast enhanced magnetic resonance imaging; Surgically induced contrast enhancement; Neurosurgery

Core tip: The amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve maximum brain tumor removal, while preventing damage to “eloquent” brain regions, a variety of technical advances have been introduced, including intraoperative magnetic resonance imaging. Brain shift can thus be compensated; however, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired images. Recently, perfusion techniques (dynamic contrast enhanced magnetic resonance imaging, dynamic susceptibility contrast magnetic resonance imaging) have been introduced that can differentiate residual tumor from surgically induced changes and thus overcome this remaining uncertainty in high grade brain tumor resection.