Reliable? The Value of Early Postoperative Magnetic Resonance Imaging after CCM Surgery.

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Reliable? The Value of Early Postoperative Magnetic Resonance Imaging after CCM Surgery.

World Neurosurg. 2017 Apr 05;:

Authors: Chen B, Göricke S, Wrede K, Jabbarli R, Jaegersberg M, Sure U, Dammann P

Abstract
BACKGROUND: Cerebral cavernous malformations (CCM) can cause intracerebral hemorrhage. The lesions themselves are frequently associated with perifocal hemosiderin deposits due to repetitive microhemorrhages. Main indications for a surgical treatment are recurrent symptomatic hemorrhages or cavernoma-related epilepsy (CRE). After surgical resection, follow-up MR-imaging is usually performed to confirm a) the complete resection of the CCM and, especially in cases of CRE, b) the complete resection of the hemosiderin deposits.
MATERIAL AND METHODS: This prospective study evaluates the value of early postoperative MRI (within 72 hours) regarding the detection of CCM or hemosiderin remnants compared to 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% 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%). Due to the high number of patients that could not be evaluated due to imaging artifacts, sensitivity and specificity analysis was not performed for early postoperative MRI using T2*/SWI 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%).
CONCLUSION: Our data suggests that early postoperative MRI after CCM surgery is often hampered by imaging artefacts 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.

PMID: 28391022 [PubMed - as supplied by publisher]

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