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Supratentorial Low-Grade Glioma Resectability: Statistical Predictive Analysis Based on Anatomic MR Features and Tumor Characteristics¹

¹ From the Departments of Radiology (I.F.T., K.H.Z., L.O., J.G.B., R.K., F.A.J.) and Neurosurgery (P.M.B.), Brigham and Women's Hospital; Department of Health Care Policy (K.H.Z.); and Division of Health Sciences & Technology (L.O.), Harvard Medical School, 75 Francis Street, Boston, MA 02115. Received April 20, 2005; revision requested June 15; revision received June 25; final version accepted July 20. Supported by NIH grants R01-LM007861, P41-RR13218, P01CA67165, and P41-RR019703. Address correspondence to I.F.T. (e-mail: talos{at}bwh.harvard.edu).

Purpose: To retrospectively assess the main variables that affect the complete magnetic resonance (MR) imaging–guided resection of supratentorial low-grade gliomas.

Materials and Methods: Institutional review board approval was obtained for this retrospective HIPAA-compliant study, with the requirement for informed consent waived. Data from 101 patients (61 men, 40 women; mean age, 39 years; age range, 18–72 years) who had nonenhancing supratentorial mass lesions that were histopathologically diagnosed as low-grade (World Health Organization grade II) gliomas and consecutively underwent surgery with intraoperative MR imaging guidance were analyzed. There were 21 low-grade astrocytomas, 64 oligodendrogliomas, and 16 mixed oligoastrocytomas. Initial and residual tumor volumes were measured on intraoperative T2-weighted MR images and three-dimensional spoiled gradient-echo MR images. The anatomic relationships between the tumor and eloquent cortical and/or subcortical regions and the influence of these relationships on the extent of resection were analyzed on the basis of preoperative MR imaging findings. Summary measures, univariate Fisher exact test and t test, and multivariate logistic regression analyses were performed.

Results: Tumor volume ranged from 2.7–231.0 mL. Univariate analyses revealed the following tumor characteristics to be significant predictive variables of incomplete tumor resection: diffuse tumor margin on T2-weighted MR images, oligodendroglioma or oligoastrocytoma histopathologic type, and large tumor volume (P < .05 for all). Tumor involvement of the following structures was associated with incomplete resection: corpus callosum, corticospinal tract, insular lobe, middle cerebral artery, motor cortex, optic radiation, visual cortex, and basal ganglia (P < .05 for all). Multivariate analyses revealed that incomplete tumor resection was due to tumor involvement of the corticospinal tract (P < .01), large tumor volume (P < .01), and oligodendroglioma histopathologic type (P = .02).

Conclusion: The main variables associated with incomplete tumor resection in 101 patients were identified by using statistical predictive analyses.

© RSNA, 2006