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Acta Neurochirurgica

, Volume 161, Issue 3, pp 555–565 | Cite as

Early postoperative MRI after resection of brain metastases—complete tumour resection associated with prolonged survival

  • Ida Christine OlesrudEmail author
  • Mette Katrine Schulz
  • Ljubo Marcovic
  • Bjarne Winther Kristensen
  • Christian Bonde Pedersen
  • Charlotte Kristiansen
  • Frantz Rom Poulsen
Original Article - Brain Tumors
Part of the following topical collections:
  1. Brain Tumors

Abstract

Background

This study aimed to investigate the incidence of residual tumour after resection of brain metastases using early postoperative magnetic resonance imaging (MRI) and the influence of residual tumour on overall patient survival.

Methods

Data from 72 consecutive adult patients undergoing surgery for cerebral metastases over an 18-month study period were retrospectively collected. Early postoperative MRI was used to determine the presence of postoperative residual tumour. Patients were divided into three groups according to the presence of tumour remnant on early postoperative MRI: “no residual tumour”, “non-measurable residual tumour” and “measurable residual tumour”. Survival analysis (mean estimate survival time) was performed using the Kaplan–Meier and log-rank (mantel cox) tests and compared between groups. Surgical reports were evaluated with regard to the surgeon statement about intraoperative extent of resection (EOR) and compared with the presence of tumour remnant found on the early postoperative MRI.

Results

Sixty-eight procedures were followed by early postoperative MRI. MRI verified the presence of “measurable residual tumour” following 15 procedures (22%). MRI confirmed complete resection in 57%. Gross total resection was described by the operating surgeon in 85% of the procedures. There was a significant difference in survival time after surgery between the group having no residual tumour on MRI and the group with measurable residual tumour (p = 0.025). This difference could not be explained by the differences in postoperative radiation therapy. The longest survival was found in patients with non-measurable and no residual tumour on early postoperative MRI, who also received postoperative radiotherapy.

Conclusion

Residual tumour was seen on MRI after 22% of the procedures. The intraoperative assessment of EOR performed by the surgeon diverged from the early postoperative MRI in 40% of procedures. Correct assessment of residual tumour thus requires early postoperative MRI. Measurable residual tumour on early postoperative MRI was associated with shorter overall survival independent on postoperative radiotherapy.

Keywords

Brain metastasis Brain metastases Surgery Postoperative MRI Resection 

Abbreviations

BrM

Brain metastases

MRI

Magnetic resonance imaging

EPMRI

Early postoperative magnetic resonance imaging

EOR

Extent of resection

GTR

Gross total resection

OUH

Odense University Hospital

MG

Malignant glioma

NPV

Negative predictive value

PPV

Positive predictive value

WBRT

Whole brain radiation therapy

SRS

Stereotactic radiosurgery

KPS

Karnofsky performance score

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This is a retrospective study. For this type of study, formal consent from the patients is not required.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Ida Christine Olesrud
    • 1
    Email author
  • Mette Katrine Schulz
    • 1
    • 2
  • Ljubo Marcovic
    • 3
  • Bjarne Winther Kristensen
    • 2
    • 4
  • Christian Bonde Pedersen
    • 1
    • 2
  • Charlotte Kristiansen
    • 5
  • Frantz Rom Poulsen
    • 1
    • 2
  1. 1.Department of NeurosurgeryOdense University HospitalOdenseDenmark
  2. 2.Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided ExcellenceUniversity of Southern DenmarkOdenseDenmark
  3. 3.Department of NeuroradiologyOdense University HospitalOdenseDenmark
  4. 4.Department of PathologyOdense University HospitalOdenseDenmark
  5. 5.Department of OncologyOdense University HospitalOdenseDenmark

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