• Amar S Shah, Alexander T Yahanda, Peter T Sylvester, John Evans, Gavin P Dunn, Randy L Jensen, John Honeycutt, Daniel P Cahill, Garnette R Sutherland, Mark Oswood, Mitesh Shah, Steven R Abram, Keith M Rich, Joshua L Dowling, Eric C Leuthardt, Ralph G Dacey, Albert H Kim, Gregory J Zipfel, David D Limbrick, Matthew D Smyth, Jeffrey Leonard, and Michael R Chicoine.
• Washington University School of Medicine, St. Louis, Missouri.
• Neurosurgery. 2020 Dec 15; 88 (1): E49E59E49-E59.

BackgroundIntraoperative magnetic resonance imaging (iMRI) is a powerful tool for guiding brain tumor resections, provided that it accurately discerns residual tumor.ObjectiveTo use histopathology to assess how reliably iMRI may discern additional tumor for a variety of tumor types, independent of the indications for iMRI.MethodsA multicenter database was used to calculate the odds of additional resection during the same surgical session for grade I to IV gliomas and pituitary adenomas. The reliability of iMRI for identifying residual tumor was assessed using histopathology of tissue resected after iMRI.ResultsGliomas (904/1517 cases, 59.6%) were more likely than pituitary adenomas (176/515, 34.2%) to receive additional resection after iMRI (P < .001), but these tumors were equally likely to have additional tissue sent for histopathology (398/904, 44.4% vs 66/176, 37.5%; P = .11). Tissue samples were available for resections after iMRI for 464 cases, with 415 (89.4%) positive for tumor. Additional resections after iMRI for gliomas (361/398, 90.7%) were more likely to yield additional tumor compared to pituitary adenomas (54/66, 81.8%) (P = .03). There were no significant differences in resection after iMRI yielding histopathologically positive tumor between grade I (58/65 cases, 89.2%; referent), grade II (82/92, 89.1%) (P = .98), grade III (72/81, 88.9%) (P = .95), or grade IV gliomas (149/160, 93.1%) (P = .33). Additional resection for previously resected tumors (122/135 cases, 90.4%) was equally likely to yield histopathologically confirmed tumor compared to newly-diagnosed tumors (293/329, 89.0%) (P = .83).ConclusionHistopathological analysis of tissue resected after use of iMRI for grade I to IV gliomas and pituitary adenomas demonstrates that iMRI is highly reliable for identifying residual tumor.Copyright © 2020 by the Congress of Neurological Surgeons.

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