Tailored Intraoperative MRI Strategies in High-Grade Glioma Surgery: A Machine Learning-Based Radiomics Model Highlights Selective Benefits.

Autor:	Aichholzer M; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Rauch P; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Kastler L; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Pichler J; Institute of Neuro-Oncology, Kepler University Hospital, Linz, Austria., Aufschnaiter-Hiessböck K; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Ruiz-Navarro F; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Aspalter S; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Hartl S; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Schimetta W; Institute of Statistics, Johannes Kepler University, Linz, Austria., Böhm P; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Manakov I; ImFusion GmbH, Munich, Germany., Thomae W; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Gmeiner M; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Gruber A; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria., Stefanits H; Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
Jazyk:	angličtina
Zdroj:	Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2023 Dec 22. Date of Electronic Publication: 2023 Dec 22.
DOI:	10.1227/ons.0000000000001023
Abstrakt:	Background and Objectives: In high-grade glioma (HGG) surgery, intraoperative MRI (iMRI) has traditionally been the gold standard for maximizing tumor resection and improving patient outcomes. However, recent Level 1 evidence juxtaposes the efficacy of iMRI and 5-aminolevulinic acid (5-ALA), questioning the continued justification of iMRI because of its associated costs and extended surgical duration. Nonetheless, drawing from our clinical observations, we postulated that a subset of intricate HGGs may continue to benefit from the adjunctive application of iMRI. Methods: In a prospective study of 73 patients with HGG, 5-ALA was the primary technique for tumor delineation, complemented by iMRI to detect residual contrast-enhanced regions. Suboptimal 5-ALA efficacy was defined when (1) iMRI detected contrast-enhanced remnants despite 5-ALA's indication of a gross total resection or (2) surgeons observed residual fluorescence, contrary to iMRI findings. Radiomic features from preoperative MRIs were extracted using a U2-Net deep learning algorithm. Binary logistic regression was then used to predict compromised 5-ALA performance. Results: Resections guided solely by 5-ALA achieved an average removal of 93.14% of contrast-enhancing tumors. This efficacy increased to 97% with iMRI integration, albeit not statistically significant. Notably, for tumors with suboptimal 5-ALA performance, iMRI's inclusion significantly improved resection outcomes (P-value: .00013). The developed deep learning-based model accurately pinpointed these scenarios, and when enriched with radiomic parameters, showcased high predictive accuracy, as indicated by a Nagelkerke R2 of 0.565 and a receiver operating characteristic of 0.901. Conclusion: Our machine learning-driven radiomics approach predicts scenarios where 5-ALA alone may be suboptimal in HGG surgery compared with its combined use with iMRI. Although 5-ALA typically yields favorable results, our analyses reveal that HGGs characterized by significant volume, complex morphology, and left-sided location compromise the effectiveness of resections relying exclusively on 5-ALA. For these intricate cases, we advocate for the continued relevance of iMRI. (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
Databáze:	MEDLINE
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