Sensitivity of three-dimensional time-of-flight 3.0 ​T magnetic resonance angiography in visualizing the number and course of lenticulostriate arteries in patients with insular gliomas

Background: Neurosurgical resection of insular gliomas is complicated by the possibility of iatrogenic injury to the lenticulostriate arteries (LSAs) and is associated with devastating neurological complications, hence the need to accurately assess the number of LSAs and their relationship to the tumor preoperatively. Methods: The study included 24 patients with insular gliomas who underwent preoperative 3D-TOF MRA to visualize LSAs. The agreement of preoperative magnetic resonance imaging with intraoperative data in terms of the number of LSAs and their invasion by the tumor was assessed using the Kendall rank correlation coefficient and Cohen's Kappa with linear weighting. Agreement between experts performing image analysis was estimated using Cohen's Kappa with linear weighting. Results: The number of LSAs arising from the M1 segment varied from 0 to 9 (mean 4.3 ​± ​0.37) as determined by 3D-TOF MRA and 2–6 (mean 4.25 ​± ​0.25) as determined intraoperatively, κ ​= ​0.51 (95% CI: 0.25–0.76) and τ ​= ​0.64 (p ​< ​0.001). LSAs were encased by the tumor in 11 patients (confirmed intraoperatively in 9 patients). LSAs were displaced medially in 8 patients (confirmed intraoperatively in 8 patients). The tumor partially involved the LSAs and displaced them in 5 patients (confirmed intraoperatively in 7 patients), κ ​= ​0.87 (95% CI: 0.70–1), τ ​= ​0.93 (p ​< ​0.001). 3D-TOF MRA demonstrated high sensitivity (100%, 95% CI: 0.63–1) and high specificity (86.67%, 95% CI: 0.58–0.98) in determining the LSA–tumor interface. Conclusions: 3D-TOF MRA at 3T demonstrated sensitivity in determining the LSA–tumor interface and the number of LSAs in patients with insular gliomas. © 2021 The Authors