Authors' objectives:

To provide an overview of the use of real-time magnetic resonance imaging (MRI) during interventional and surgical procedures with respect to safety, efficacy/effectiveness, cost, and utilisation within Canada. The report will be used to assist Capital Health in future planning decisions on interventional/intraoperative MRI capacity within the health region.

Authors' results and conclusions: Only four non-randomised comparative studies met the inclusion criteria: one on interventional MRI and three on intraoperative MRI. Patients who underwent interventional MRI guided brain biopsy had similar postoperative morbidity rates to those who underwent a stereotactic technique. However, one fatality occurred following conventional stereotactic biopsy, whereas no deaths occurred in the interventional MRI group. Using intraoperative MRI to monitor brain tumour resection resulted in a substantial increase in operative time, compared to conventional surgery, but with no discernible effect on the perioperative anesthetic outcome of patients. Conversely, the hospital stay was generally shorter after the intraoperative MRI procedure. The use of intraoperative MRI for resection control of supratentorial cavernous hemangiomas made no difference to the amount of pathology resected, compared to standard neuronavigation techniques, whereas significantly more tumour volume was resected in patients with high grade gliomas. None of the included studies reported any adverse events directly related to the use of intraoperative MRI, but this was also true for the conventional procedures that intraoperative MRI was compared to. The results may underestimate the capabilities of interventional/intraoperative MRI because of substantial confounding from the learning curve effect, but the presence of methodological flaws in the studies made it impossible to characterise the overall magnitude or direction of these biases. Thus, it is unclear whether the equivocal results are a consequence of limitations in study design, the interventional/intraoperative MRI procedure itself, or both. The included studies only used MRI as a tool to guide or monitor interventional and operative neurosurgical procedures. Therefore, the clinical utility of using MRI to guide or monitor any other type of intervention or surgery, such as percutaneous biopsy or endoscopic abdominal surgery, is unknown. There are currently four interventional/intraoperative MRI facilities in Canada, which are located in Calgary, Winnipeg, Quebec City, and Toronto. Two other centres in Halifax and Ottawa may acquire an interventional/intraoperative MRI unit in the near future.

Authors' recommendations: Interventional and intraoperative MRI is a high cost, developmental technology for which no major safety concerns have been identified to date. Due to its recent genesis, the scope, applicability, efficacy, and cost effectiveness of this technology have not been established. Concurrently controlled studies assessing the impact of interventional/intraoperative MRI on patient management and outcomes will provide the information required to resolve the question of whether interventional/intraoperative MRI has a broader clinical application beyond its current use in the research setting. As more interventional/intraoperative MRI systems are installed, such trials may become feasible.

Authors' methods: Review

Project Status: Completed

Year Published: 2004

URL for published report: https://www.ihe.ca/advanced-search?type=1020

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute of Health Economics

Contact Address: 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4. Tel: +1 780 448 4881; Fax: +1 780 448 0018;

Contact Name: djuzwishin@ihe.ca

Contact Email: djuzwishin@ihe.ca

Copyright: <p>Alberta Heritage Foundation for Medical Research (AHFMR)</p>