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<meta name="DC.Title" content="3T Intraoperative MRI for Management of Pediatric CNS Neoplasms" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4040" />
<meta name="DC.Date" content="2014-08-28" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: High-field-strength intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-intraoperative MRI on the surgical management of childhood CNS tumors.

MATERIALS AND METHODS: We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging–related complications were evaluated. Comparison with pre-intraoperative MRI controls was performed.

RESULTS: One hundred ninety-four patients underwent intraoperative MRI–guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma ( n = 31, 19%), low-grade glioma ( n = 31, 19%), and medulloblastoma ( n = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging–related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was &lt;1% ( n = 1), and no patient required additional postoperative MR imaging during the same hospital stay.

CONCLUSIONS: Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors.

### Abbreviations

FSPGR
:   fast-spoiled gradient recalled
iMRI
:   intraoperative MRI" />
<meta name="DC.Contributor" content="A.F. Choudhri" />
<meta name="DC.Contributor" content="P. Klimo" />
<meta name="DC.Contributor" content="T.S. Auschwitz" />
<meta name="DC.Contributor" content="M.T. Whitehead" />
<meta name="DC.Contributor" content="F.A. Boop" />
<meta name="article:published_time" content="2014-08-28" />
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<meta name="citation_title" content="3T Intraoperative MRI for Management of Pediatric CNS Neoplasms" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;High-field-strength intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-intraoperative MRI on the surgical management of childhood CNS tumors.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We evaluated patient data from a single academic children9s hospital during a consecutive 24-month period after installation of a 3T-intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging–related complications were evaluated. Comparison with pre-intraoperative MRI controls was performed.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;One hundred ninety-four patients underwent intraoperative MRI–guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma (&lt;i&gt;n&lt;/i&gt; = 31, 19%), low-grade glioma (&lt;i&gt;n&lt;/i&gt; = 31, 19%), and medulloblastoma (&lt;i&gt;n&lt;/i&gt; = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging–related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was &amp;lt;1% (&lt;i&gt;n&lt;/i&gt; = 1), and no patient required additional postoperative MR imaging during the same hospital stay.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors.&lt;/p&gt;" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: High-field-strength intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-intraoperative MRI on the surgical management of childhood CNS tumors.

MATERIALS AND METHODS: We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging–related complications were evaluated. Comparison with pre-intraoperative MRI controls was performed.

RESULTS: One hundred ninety-four patients underwent intraoperative MRI–guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma ( n = 31, 19%), low-grade glioma ( n = 31, 19%), and medulloblastoma ( n = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging–related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was &lt;1% ( n = 1), and no patient required additional postoperative MR imaging during the same hospital stay.

CONCLUSIONS: Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors.

### Abbreviations

FSPGR
:   fast-spoiled gradient recalled
iMRI
:   intraoperative MRI" />
<meta name="og-title" property="og:title" content="3T Intraoperative MRI for Management of Pediatric CNS Neoplasms" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2014/08/28/ajnr.A4040" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: High-field-strength intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-intraoperative MRI on the surgical management of childhood CNS tumors.

MATERIALS AND METHODS: We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging–related complications were evaluated. Comparison with pre-intraoperative MRI controls was performed.

RESULTS: One hundred ninety-four patients underwent intraoperative MRI–guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma ( n = 31, 19%), low-grade glioma ( n = 31, 19%), and medulloblastoma ( n = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging–related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was &lt;1% ( n = 1), and no patient required additional postoperative MR imaging during the same hospital stay.

CONCLUSIONS: Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors.

### Abbreviations

FSPGR
:   fast-spoiled gradient recalled
iMRI
:   intraoperative MRI" />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node50787--5" data-node-nid="50787" id="top-node-50787--61894789629" data-pisa="ajnr;ajnr.A4040v2" data-pisa-master="ajnr;ajnr.A4040" data-apath="/ajnr/early/2014/08/28/ajnr.A4040.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">PEDIATRICS</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">3T Intraoperative MRI for Management of Pediatric CNS Neoplasms</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A.F. Choudhri</span>, <span class="highwire-citation-author" data-delta="1">P. Klimo</span>, <span class="highwire-citation-author" data-delta="2">T.S. Auschwitz</span>, <span class="highwire-citation-author" data-delta="3">M.T. Whitehead</span> and <span class="highwire-citation-author" data-delta="4">F.A. Boop</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2014,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4040 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-50787--61894789629" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A.F. Choudhri </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (A.F.C., M.T.W.), Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.), and Ophthalmology (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children’s Hospital, Memphis, Tennessee; Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee; Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children’s Hospital, Memphis, Tennessee; and Department of Radiology (M.T.W.), Children’s National Medical Center, Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.F.%2BChoudhri%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Choudhri%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.F.%2BChoudhri%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-5786-194X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.F. Choudhri</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">P. Klimo <span class="nlm-suffix">Jr</span></div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (A.F.C., M.T.W.), Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.), and Ophthalmology (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children’s Hospital, Memphis, Tennessee; Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee; Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children’s Hospital, Memphis, Tennessee; and Department of Radiology (M.T.W.), Children’s National Medical Center, Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BKlimo%2B%3Cspan%2Bclass%3D%22nlm-suffix%22%3EJr%3C/span%3E" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Klimo%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BKlimo%2BJr" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">T.S. Auschwitz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (A.F.C., M.T.W.), Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.), and Ophthalmology (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children’s Hospital, Memphis, Tennessee; Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee; Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children’s Hospital, Memphis, Tennessee; and Department of Radiology (M.T.W.), Children’s National Medical Center, Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.S.%2BAuschwitz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Auschwitz%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AT.S.%2BAuschwitz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M.T. Whitehead </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (A.F.C., M.T.W.), Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.), and Ophthalmology (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children’s Hospital, Memphis, Tennessee; Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee; Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children’s Hospital, Memphis, Tennessee; and Department of Radiology (M.T.W.), Children’s National Medical Center, Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.T.%2BWhitehead%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Whitehead%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.T.%2BWhitehead%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">F.A. Boop </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Radiology (A.F.C., M.T.W.), Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.), and Ophthalmology (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children’s Hospital, Memphis, Tennessee; Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee; Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children’s Hospital, Memphis, Tennessee; and Department of Radiology (M.T.W.), Children’s National Medical Center, Washington, DC.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.A.%2BBoop%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Boop%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AF.A.%2BBoop%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> High-field-strength intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-intraoperative MRI on the surgical management of childhood CNS tumors.</p></div>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging–related complications were evaluated. Comparison with pre-intraoperative MRI controls was performed.</p></div>
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<p id="p-3"><strong>RESULTS:</strong> One hundred ninety-four patients underwent intraoperative MRI–guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma (<em>n</em> = 31, 19%), low-grade glioma (<em>n</em> = 31, 19%), and medulloblastoma (<em>n</em> = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging–related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was &lt;1% (<em>n</em> = 1), and no patient required additional postoperative MR imaging during the same hospital stay.</p></div>
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<p id="p-4"><strong>CONCLUSIONS:</strong> Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors.</p>
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<h3>Abbreviations</h3>
<dl id="def-list-1"><dt id="def-item-1">FSPGR<span class="def-item-dt-sep"></span></dt><dd>fast-spoiled gradient recalled<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">iMRI<span class="def-item-dt-sep"></span></dt><dd>intraoperative MRI</dd></dl>
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