title: Value of Early Postoperative FLAIR Volume Dynamic in Glioma with No or Minimal Enhancement.
abstract: OBJECTIVE
  The evaluation of postoperative magnetic resonance imaging (MRI) in glioma with no or minimal enhancement is controversial because the evaluation of residual tumor volume can be biased. The purpose of this study was to clarify the value of early postoperative and 3-month MRI regarding its validity in predicting recurrent disease.
  
  
  METHODS
  For this retrospective, single-center study, overall fluid attenuated inversion recovery (FLAIR) volumes (early postoperative [<48 hours] and 3-month MRI including FLAIR and T1-weighted sequences with and without contrast agent) of 99 patients were assessed using manual segmentation. FLAIR volume dynamic over the first 3 months after surgery and its effect on disease recurrence were evaluated while considering histopathologic features.
  
  
  RESULTS
  Overall FLAIR-hyperintense volume significantly decreased between early postoperative and 3-month follow-up MRIs (P < 0.001). Early FLAIR volume increase had a high positive predictive value for overall disease recurrence after resection (85.71% [95%-CI: 62.64-96.24]). Early FLAIR volume dynamic (P < 0.001), isocitrate dehydrogenase 1/2 status (P = 0.002), and preoperative Karnofsky Performance Status (P = 0.012) were observed as independent factors for progression-free survival in multivariate analysis.
  
  
  CONCLUSIONS
  Early postoperative FLAIR volume assessment in gliomas with no or minimal enhancement is susceptible to a systematic overestimation of residual tumors. Nevertheless, early FLAIR volume dynamic is an independent factor for tumor recurrence that should be evaluated in order timely adapt surveillance and therapy regimens accordingly.
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: stefanie.bette@tum.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Bette
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kaesmacher
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Huber
authors.affiliation: Department of Neuropathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Claire
authors.initials: C
authors.lastname: Delbridge
authors.affiliation: Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Boeckh-Behrens
authors.affiliation: Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Kirschke
authors.affiliation: Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gempt
mesh_terms: D000328:Adult; D020520:Brain Infarction / Q000401:mortality / Q000473:pathology; D002545:Brain Ischemia / Q000401:mortality / Q000473:pathology; D001932:Brain Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007521:Isocitrate Dehydrogenase / Q000235:genetics; D017567:Karnofsky Performance Status; D008297:Male; D009154:Mutation; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D047368:Tumor Burden
chemical_list: C538784:IDH2 protein, human; D007521:Isocitrate Dehydrogenase; C543588:IDH1 protein, human
keywords: Early postoperative MRI; Low-grade glioma; No enhancement