title: Reliable? The Value of Early Postoperative Magnetic Resonance Imaging after Cerebral Cavernous Malformation Surgery.
abstract: BACKGROUND
  Cerebral cavernous malformations (CCM) can cause intracerebral hemorrhage. The lesions themselves are frequently associated with perifocal hemosiderin deposits caused by repetitive microhemorrhages. Main indications for a surgical treatment are recurrent symptomatic hemorrhages or cavernoma-related epilepsy. After surgical resection, follow-up magnetic resonance imaging (MRI) is usually performed to confirm 1) the complete resection of the CCM and, especially in cases of cavernoma-related epilepsy, 2) the complete resection of the hemosiderin deposits.
  
  
  METHODS
  This prospective study evaluates the value of early postoperative MRI (within 72 hours) regarding the detection of CCM or hemosiderin remnants compared with a standard 3-6 months postoperative MRI control in 61 CCM cases.
  
  
  RESULTS
  Sensitivity of early postoperative MRI for CCM remnant detection was 66.67% (95% confidence interval [CI], 9.43%-99.16%), specificity was 76.74% (95% CI, 61.37%-88.24%), positive predictive value was 16.67% (95% CI, 2.09%-48.41%), and negative predictive value was 97.06% (95% CI, 84.67%-99.93%). Because of the high number of patients who could not be evaluated because of imaging artifacts, sensitivity and specificity analysis was not performed for early postoperative MRI using T2*/susceptibility-weighted imaging to assess hemosiderin remnants. Sensitivity of early postoperative MRI for hemosiderin remnant detection using T2-weighted sequences was 85.71% (95% CI, 63.66%-96.95%), specificity was 66.67% (95% CI, 44.68%-84.37%), positive predictive value was 69.23% (95% CI, 55.45%-80.27%), and negative predictive value was 84.21% (95% CI, 64.31%-94.04%).
  
  
  CONCLUSIONS
  Our data suggest that early postoperative MRI after CCM surgery is often hampered by imaging artifacts creating false-positive results and therefore ineligible for a resection control. However, reliability of a negative result on early postoperative T2-weighted MRI is relatively high regarding both CCM and hemosiderin remnants.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Essen, Germany. Electronic address: bixia.chen@uk-essen.de.
authors.forename: Bixia
authors.initials: B
authors.lastname: Chen
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Göricke
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Essen, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Wrede
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Essen, Germany.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Jabbarli
authors.affiliation: Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wälchli
authors.affiliation: Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Max
authors.initials: M
authors.lastname: Jägersberg
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Essen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Essen, Germany; Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dammann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004827:Epilepsy; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D006485:Hemosiderin
keywords: CCM; Cavernoma; Cavernous malformation; MRI; SWI