title: Altered intraoperative cerebrovascular reactivity in brain areas of high-grade glioma recurrence.
abstract: Current MRI sequences are limited in identifying brain areas at risk for high grade glioma recurrence. We employed intraoperative 3-Tesla functional MRI to assess cerebrovascular reactivity (CVR) after high-grade glioma resection and analyzed regional CVR responses in areas of tumor recurrence on clinical follow-up imaging.
  
  
  
  Five subjects with high-grade glioma that underwent an intraoperative Blood Oxygen-Level Dependent (BOLD) MRI CVR examination and had a clinical follow-up of at least 18months were selected from a prospective database. For this study, location of tumor recurrence was spatially matched to the intraoperative imaging to assess CVR response in that particular area. CVR is defined as the percent BOLD signal change during repeated cycles of apnea.
  
  
  
  Of the 5 subjects (mean age 44, 2 females), 4 were diagnosed with a WHO grade III and 1 subject with a WHO grade IV glioma. Three subjects exhibited a tumor recurrence on clinical follow-up MRI (mean: 15months). BOLD CVR measured in the spatially matched area of tumor recurrence was on average 94% increased (range-32% to 183%) as compared to contralateral hemisphere CVR response, 1.50±0.81 versus 1.03±0.46 respectively (p=0.31).
  
  
  
  For this first analysis in a small cohort, we found altered intraoperative CVR in brain areas exhibiting high grade glioma recurrence on clinical follow-up imaging.
authors.affiliation: Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland. Electronic address: jorn.fierstra@usz.ch.
authors.forename: Jorn
authors.initials: J
authors.lastname: Fierstra
authors.affiliation: Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Bas
authors.initials: B
authors.lastname: van Niftrik
authors.affiliation: Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Piccirelli
authors.affiliation: Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Jan Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.affiliation: Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Athina
authors.initials: A
authors.lastname: Pangalu
authors.affiliation: Department of Neuro-anesthesia, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Roman
authors.initials: R
authors.lastname: Kocian
authors.affiliation: Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Antonios
authors.initials: A
authors.lastname: Valavanis
authors.affiliation: Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Weller
authors.affiliation: Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
authors.affiliation: Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bozinov
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies
keywords: Blood oxygen-level dependent; Cerebrovascular reactivity; Functional MRI; High-grade cerebral glioma; Intraoperative