Intraoperative dynamic susceptibility contrast MRI (iDSC-MRI) is as reliable as preoperatively acquired perfusion mapping

DSC-MRI was applied intraoperatively during human brain tumor removal. Immediately after complete tumor resection was presumed, MRI including a dynamic susceptibility contrast T2-weighted EPI sequence was performed in 30 patients while the skull was still open using a flexible two-channel coil system at an intraoperative 1.5-Tesla MR scanner. Maps of relative regional blood flow (rCBF), blood volume (rCBV), and mean transit time (MTT) were calculated, and ratios of these maps were compared to preoperatively acquired DSC-MRI data. The extent of the resection was compared with the postoperative MRI performed 24 h after the operation. In 8 of these patients residual tumor tissue was depicted at the time of intraoperative MRI. In corresponding regions ratios for rCBV and rCBF did not differ significantly between pre- and intraoperatively acquired data (two-tailed t-test). Furthermore, we found a high correlation between ratios created from pre- and intraoperatively measured data for both rCBV and rCBF, respectively (Pearson correlation; r(2)(rCBV)=0.86, p<or=0.01; r(2)(rCBF)=0.86, p<or=0.01). DSC-MRI is a powerful tool for the differential diagnosis of brain lesions. Its use intraoperatively provides pathophysiologic information that is up-to-date, independently of an intraoperative brain shift and also independently of the known leakage phenomenon caused by surgical manipulation. It can assist in the decision to depict residual tumor burden beyond conventional imaging. Our data demonstrate that iDSC-MRI is as reliable as preoperatively acquired data.