• Flávia Sprenger, Erasmo Barros da Silva Junior, Ricardo Ramina, Marcela Santos Cavalcanti, Samuel Botter Martins, Matheus Abrantes Cerqueira, Alexandre Xavier Falcão, and Corrêa de Almeida TeixeiraBernardoBDepartment of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil..
• Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil. Electronic address: flaviasprenger@gmail.com.
• World Neurosurg. 2024 Sep 1; 189: e230e237e230-e237.

BackgroundMalignant gliomas are the most prevalent primary malignant cerebral tumors. Preoperative imaging plays an important role, and the prognosis is closely related to surgical resection and histomolecular aspects. Our goal was to correlate Ki67 indexes with tumoral volumetry in semiautomatic segmentation on preoperative magnetic resonance images and residual fluorescence in a 5-ALA-assisted resection cohort.MethodsWe included 86 IDH-wildtype glioblastoma patients with complete preoperative imaging submitted to 5-ALA assisted resections. Clinical, surgical, and histomolecular findings were also obtained. Preoperative magnetic resonance studies were preprocessed and segmented semiautomatically on Visualization and Analysis for whole tumor (WT) on 3D FLAIR, enhancing tumor (ET), and necrotic core on 3D postgadolinium T1. We performed a linear regression analysis for Ki67 and a multivariate analysis for surgical outcomes.ResultsHigher Ki-67 indexes correlated positively with higher WT (P = 0.048) and ET (P = 0.002). Lower Ki67 correlated with 5-ALA free margins (P = 0.045). WT and ET volumes correlated with the extent of resection (EOR; P = 0.002 and 0.002, respectively). Eloquence did not impact EOR (P = 0.14).ConclusionsThere is a correlation between Ki67, the metabolically active tumoral volumes (WT and ET), and 5-ALA residual fluorescence. Methodological inconsistencies are probably responsible for contradictory literature findings, and further prospective studies are needed to validate and reproduce these findings.Copyright © 2024 Elsevier Inc. All rights reserved.

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