The Role of FIESTA MRI for Assessment of Delayed Enhancement of Fat Graft Packing on Post-Operative Imaging After Vestibular Schwannoma Surgery.

The Role of FIESTA MRI for Assessment of Delayed Enhancement of Fat Graft Packing on Post-Operative Imaging After Vestibular Schwannoma Surgery.

World Neurosurg. 2018 Mar 29;:

Authors: Kamal N, Reddy R, Kohli G, Lee HJ, Mary Ying YL, Jyung RW, Liu JK

Abstract
OBJECT: This study investigates the role and efficacy of FIESTA imaging in distinguishing fat graft enhancement from residual or recurrent tumor after vestibular schwannoma (VS) surgery.
METHODS: A retrospective study of 33 patients who underwent VS resection via the retrosigmoid or translabyrinthine approach with fat graft reconstruction was performed. MR images were collected at different time points: preoperative, immediate postoperative (24-48 hours), delayed postoperative (3-6 months after surgery), and yearly postoperative. The image sets contained T1, T2, Fat Suppressed T1-weighted with Gadolinium, and FIESTA. The radiographs were analyzed for tumor recurrence by the primary neurosurgeon and an independent blinded neuroradiologist. If fat suppressed T1-weighted images demonstrated postoperative enhancement in the resection bed, a comparison was made with FIESTA imaging.
RESULTS: At 3-6 months postoperatively and at 1 year and beyond, 28 (84.8%) and 33 (100%) of patients, respectively, displayed delayed enhancement of the fat graft on post-gadolinium fat-suppressed T1 MRI. The enhancement seen on post-gadolinium fat-suppressed T1-weighted MRI consistently correlated with the characteristic fat graft signal on FIESTA imaging and not tumor recurrence. FIESTA imaging was able to distinguish residual tumor from enhancing fat graft compared to post-gadolinium fat-suppressed T1-weighted MR images (p<0.0001) due to distinctive signaling patterns.
CONCLUSION: FIESTA is an effective tool in discerning fat graft enhancement from residual or recurrent tumor on delayed postoperative imaging after VS resection. Fat graft used in reconstruction consistently enhances on delayed postoperative post-gadolinium fat suppressed T1-weighted imaging, which correlates with the fat graft signal seen on FIESTA images.

PMID: 29605696 [PubMed - as supplied by publisher]

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