Intraoperative magnetic resonance imaging for low- and high-grade gliomas: what is the evidence? A meta-analysis.

2021 
Abstract: Introduction The benefit of intraoperative magnetic resonance imaging (iMRI) in gliomas remains unclear. We performed a meta-analysis of outcomes with iMRI-guided surgery in high- and low-grade gliomas (HGG and LGG). Methods Databases were searched through 11/29/18 for randomized controlled trials (RCT) and observational studies (OBS) comparing iMRI use to conventional neurosurgery. Pooled risk ratios (RR) or hazard ratios (HR) were evaluated with the random-effects model. Outcome included extent of resection (EOR), gross total resection (GTR), progression-free survival (PFS), overall survival (OS), and length of surgery (LOS), stratified by study design and glioma grade. Results Fifteen articles (3 RCTs and 12 OBS) were included. In RCTs, GTR incidence was higher in iMRI compared to conventional neurosurgery (RR 1.42, 95% CI: 1.17-1.73; I2: 7%) overall, for LGGs (1.91, 95% CI: 1.19-3.06), but not HGGs (1.24, 95% CI: 0.89-1.73); with no difference in EOR, PFS, OS and LOS. For OBS, GTR incidence was higher (RR: 1.65, 95% CI: 1.43-1.90; I2: 4%) overall, and for LGGs (1.63, 95% CI: 1.17-2.28; I2: 0%) and HGGs (1.62, 95% CI: 1.36-1.92; I2: 19%). EOR was greater with iMRI (6%, 95% CI: 4%-8%; I2: 44%) overall, in LGGs (5%, 95% CI: 2%-8%; I2: 37%) and HGGs (7%, 95% CI: 4%-10%; I2: 13%). There was no difference in PFS, OS and LOS with iMRI Conclusion IMRI use improved GTR incidence in gliomas, including for LGGs. There was however no PFS and OS benefit demonstrated in the included studies.
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