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Semi-Automated Volumetric and Morphological Assessment of Glioblastoma Resection with Fluorescence-Guided Surgery

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Abstract

Purpose

Glioblastoma (GBM) neurosurgical resection relies on contrast-enhanced MRI-based neuronavigation. However, it is well-known that infiltrating tumor extends beyond contrast enhancement. Fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) was evaluated to improve extent of resection (EOR) of GBMs. Preoperative morphological tumor metrics were also assessed.

Procedures

Thirty patients from a phase II trial evaluating 5-ALA FGS in newly diagnosed GBM were assessed. Tumors were segmented preoperatively to assess morphological features as well as postoperatively to evaluate EOR and residual tumor volume (RTV).

Results

Median EOR and RTV were 94.3 % and 0.821 cm3, respectively. Preoperative surface area to volume ratio and RTV were significantly associated with overall survival, even when controlling for the known survival confounders.

Conclusions

This study supports claims that 5-ALA FGS is helpful at decreasing tumor burden and prolonging survival in GBM. Moreover, morphological indices are shown to impact both resection and patient survival.

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Acknowledgments

This work was supported by National Institute of Health grants R21 CA141836 (CGH/CAH/HS), a predoctoral fellowship F31 CA180319 (JSC), and a research grant from Nx Development Corp (CGH).

Compliance with Ethical Standards

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Conflict of Interest

Dr. Costas Hadjipanayis receives intellectual fees from Nx Development Corp (Miami, Florida).

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA

    J. Scott Cordova, Saumya S. Gurbani, Chad A. Holder & Hyunsuk Shim

  2. Department of Neurosurgery, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA

    Jeffrey J. Olson & Costas G. Hadjipanayis

  3. Department of Radiation Oncology, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA

    Eduard Schreibmann & Hui-Kuo G. Shu

  4. Department of Biostatistics, Emory University School of Public Health, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA

    Ran Shi & Ying Guo

  5. Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA

    Jeffrey J. Olson, Hui-Kuo G. Shu, Hyunsuk Shim & Costas G. Hadjipanayis

  6. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, 10 Union Square, 5th Floor, Suite 5E, New York, NY, 10003, USA

    Costas G. Hadjipanayis

Authors
  1. J. Scott Cordova
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  2. Saumya S. Gurbani
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  3. Chad A. Holder
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  4. Jeffrey J. Olson
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  5. Eduard Schreibmann
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  6. Ran Shi
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  7. Ying Guo
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  8. Hui-Kuo G. Shu
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  9. Hyunsuk Shim
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  10. Costas G. Hadjipanayis
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Corresponding authors

Correspondence to Hyunsuk Shim or Costas G. Hadjipanayis.

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Cordova, J.S., Gurbani, S.S., Holder, C.A. et al. Semi-Automated Volumetric and Morphological Assessment of Glioblastoma Resection with Fluorescence-Guided Surgery. Mol Imaging Biol 18, 454–462 (2016). https://doi.org/10.1007/s11307-015-0900-2

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  • DOI: https://doi.org/10.1007/s11307-015-0900-2

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