{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:43:34Z","timestamp":1792806214134,"version":"4.5.0"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Intraoperative MRI (iMRI) is used in the surgical treatment of glioblastoma, with uncertain effects on outcomes. The authors evaluated the impact of iMRI on extent of resection (EOR) and overall survival (OS) while controlling for other known and suspected predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A multicenter retrospective cohort of 640 adult patients with newly diagnosed supratentorial glioblastoma who underwent resection was evaluated. iMRI was performed in 332\/640 cases (51.9%). Reviews of MRI features and tumor volumetric analysis were performed on a subsample of cases (n = 286; 110 non-iMRI, 176 iMRI) from a single institution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The median age was 60.0 years (mean 58.5 years, range 20.5\u201386.3 years). The median OS was 17.0 months (95% CI 15.6\u201318.4 months). Gross-total resection (GTR) was achieved in 403\/640 cases (63.0%). Kaplan-Meier analysis of 286 cases with volumetric analysis for EOR (grouped into 100%, 95%\u201399%, 80%\u201394%, and 50%\u201379%) showed longer OS for 100% EOR compared to all other groups (p &lt; 0.01). Additional resection after iMRI was performed in 104\/122 cases (85.2%) with initial subtotal resection (STR), leading to a 6.3% mean increase in EOR and a 2.2-cm\n                      <jats:sup>3<\/jats:sup>\n                      mean decrease in tumor volume. For iMRI cases with volumetric analysis, the GTR rate increased from 54\/176 (30.7%) on iMRI to 126\/176 (71.5%) postoperatively. The EOR was significantly higher in the iMRI group for intended GTR and STR groups (p = 0.02 and p &lt; 0.01, respectively). Predictors of GTR on multivariate logistic regression included iMRI use and intended GTR. Predictors of shorter OS on multivariate Cox regression included older age, STR, isocitrate dehydrogenase 1 (\n                      <jats:italic>IDH1<\/jats:italic>\n                      ) wild type, no\n                      <jats:italic>O<\/jats:italic>\n                      <jats:sup>6<\/jats:sup>\n                      -methylguanine DNA methyltransferase (MGMT) methylation, and no Stupp therapy. iMRI was a significant predictor of OS on univariate (HR 0.82, 95% CI 0.69\u20130.98; p = 0.03) but not multivariate analyses. Use of iMRI was not associated with an increased rate of new permanent neurological deficits.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>GTR increased OS for patients with newly diagnosed glioblastoma after adjusting for other prognostic factors. iMRI increased EOR and GTR rate and was a significant predictor of GTR on multivariate analysis; however, iMRI was not an independent predictor of OS. Additional supporting evidence is needed to determine the clinical benefit of iMRI in the management of glioblastoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2020.6.jns19287","type":"journal-article","created":{"date-parts":[[2020,10,9]],"date-time":"2020-10-09T03:51:05Z","timestamp":1602215465000},"page":"505-514","source":"Crossref","is-referenced-by-count":32,"title":["Intraoperative MRI for newly diagnosed supratentorial glioblastoma: a multicenter-registry comparative study to conventional surgery"],"prefix":"10.3171","volume":"135","author":[{"given":"Amar S.","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter T.","family":"Sylvester","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T.","family":"Yahanda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananth K.","family":"Vellimana","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin P.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith M.","family":"Rich","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua L.","family":"Dowling","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric C.","family":"Leuthardt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph G.","family":"Dacey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert H.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Grubb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Zipfel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Oswood","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Minnesota, Minneapolis, Minnesota;"},{"name":"Allina Health, Minneapolis, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy L.","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garnette R.","family":"Sutherland","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P.","family":"Cahill","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Abram","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Thomas Hospital, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Honeycutt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cook Children\u2019s Hospital, Fort Worth, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitesh","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Goodman Campbell and Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Chicoine","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"suppl 4","key":"b1","series-title":"Neuro Oncol","first-page":"iv1","article-title":"CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007\u20132011","volume":"16","author":"Ostrom\n \nQT","year":"2014","unstructured":"Ostrom\n \nQT\n\n, \n\nGittleman\n \nH\n\n, \n\nLiao\n \nP\n\n, \n\n\n \nCBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007\u20132011\n. \nNeuro Oncol\n. \n2014\n;\n16\n(\nsuppl 4\n):\niv1\n\u2013\niv63\n."},{"issue":"10","key":"b2","series-title":"J Clin Neurosci","first-page":"1575","article-title":"Patient and treatment factors associated with survival among adult glioblastoma patients: a USA population-based study from 2000\u20132010","volume":"22","author":"Pan\n \nIW","year":"2015","unstructured":"Pan\n \nIW\n\n, \n\nFerguson\n \nSD\n\n, \n\nLam\n \nS\n\n\n. \nPatient and treatment factors associated with survival among adult glioblastoma patients: a USA population-based study from 2000\u20132010\n. \nJ Clin Neurosci\n. \n2015\n;\n22\n(\n10\n):\n1575\n\u2013\n1581\n."},{"issue":"5","key":"b3","series-title":"Lancet Oncol","first-page":"459","article-title":"Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial","volume":"10","author":"Stupp\n \nR","year":"2009","unstructured":"Stupp\n \nR\n\n, \n\nHegi\n \nME\n\n, \n\nMason\n \nWP\n\n, \n\n\n \nEffects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial\n. \nLancet Oncol\n. \n2009\n;\n10\n(\n5\n):\n459\n\u2013\n466\n."},{"issue":"10","key":"b4","series-title":"N Engl J Med","first-page":"987","article-title":"Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma","volume":"352","author":"Stupp\n \nR","year":"2005","unstructured":"Stupp\n \nR\n\n, \n\nMason\n \nWP\n\n, \n\nvan den Bent\n \nMJ\n\n, \n\n\n \nRadiotherapy plus concomitant and adjuvant temozolomide for glioblastoma\n. \nN Engl J Med\n. \n2005\n;\n352\n(\n10\n):\n987\n\u2013\n996\n."},{"issue":"6","key":"b5","series-title":"Curr Opin Neurol","first-page":"666","article-title":"Glioblastoma survival: has it improved? 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