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Purpose <p>Extent of resection (EOR) and residual tumor volume (RTV) are key prognostic factors in lower-grade gliomas (LGGs). Intraoperative magnetic resonance imaging (iMRI) enables real-time assessment of tumor removal, but the survival relevance of sequential volumetric measures remains incompletely defined. This study evaluated the relationship between T2- and FLAIR-based imaging volumes, EOR, and survival in patients undergoing LGG resection with iMRI with long-term radiographic and clinical follow-up.</p> Methods <p>We retrospectively reviewed 90 patients with WHO Grade 2–3 LGGs who underwent iMRI-guided resection between 2011 and 2023 at a single institution. Radiographic and clinical follow-up was tracked through 2025. Volumetric analyses were performed on preoperative, intraoperative, immediate postoperative, and three-month postoperative T2-weighted and FLAIR sequences. Associations between imaging volumes, EOR, and progression-free (PFS), malignant progression-free (mPFS), and overall (OS) survival were assessed using log-rank and multivariable Cox regression analyses, including subgroup analysis by isocitrate dehydrogenase (IDH) mutation status.</p> Results <p>Median clinical and radiographic follow-up was 94.5 ± 34.8 months. Greater EOR correlated with longer survival across all metrics. In IDH-mutant tumors, FLAIR-based EOR was independently predictive of PFS (<i>p</i> ≤ 0.03), mPFS (<i>p</i> ≤ 0.02), and OS (<i>p</i> ≤ 0.02) on multivariable analysis. Additional resection after iMRI occurred in 55.6% of patients, with 90% yielding positive tumor margins, but did not independently improve survival.</p> Conclusion <p>In LGG surgery accompanied by iMRI, greater EOR and smaller residual T2/FLAIR volumes predict longer survival, particularly among IDH-mutant tumors. The use of iMRI facilitates maximal safe resection.</p>

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Lower-grade glioma imaging volumes and survival: a single-institution analysis of 90 patients after resection using intraoperative MRI

  • 期刊论文

  • 发表日期：

    2026年3月19日

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  • Jeffrey L. Nadel,
  • Nicholas T. Gamboa,
  • David Botros,
  • Brendan T. Crabb,
  • Nicholas Kendall,
  • Matthew C. Findlay,
  • Kyril L. Cole,
  • Bradley D. Weaver,
  • Randy L. Jensen

摘要

Purpose

Extent of resection (EOR) and residual tumor volume (RTV) are key prognostic factors in lower-grade gliomas (LGGs). Intraoperative magnetic resonance imaging (iMRI) enables real-time assessment of tumor removal, but the survival relevance of sequential volumetric measures remains incompletely defined. This study evaluated the relationship between T2- and FLAIR-based imaging volumes, EOR, and survival in patients undergoing LGG resection with iMRI with long-term radiographic and clinical follow-up.

Methods

We retrospectively reviewed 90 patients with WHO Grade 2–3 LGGs who underwent iMRI-guided resection between 2011 and 2023 at a single institution. Radiographic and clinical follow-up was tracked through 2025. Volumetric analyses were performed on preoperative, intraoperative, immediate postoperative, and three-month postoperative T2-weighted and FLAIR sequences. Associations between imaging volumes, EOR, and progression-free (PFS), malignant progression-free (mPFS), and overall (OS) survival were assessed using log-rank and multivariable Cox regression analyses, including subgroup analysis by isocitrate dehydrogenase (IDH) mutation status.

Results

Median clinical and radiographic follow-up was 94.5 ± 34.8 months. Greater EOR correlated with longer survival across all metrics. In IDH-mutant tumors, FLAIR-based EOR was independently predictive of PFS (p ≤ 0.03), mPFS (p ≤ 0.02), and OS (p ≤ 0.02) on multivariable analysis. Additional resection after iMRI occurred in 55.6% of patients, with 90% yielding positive tumor margins, but did not independently improve survival.

Conclusion

In LGG surgery accompanied by iMRI, greater EOR and smaller residual T2/FLAIR volumes predict longer survival, particularly among IDH-mutant tumors. The use of iMRI facilitates maximal safe resection.