Acute changes in diffusion tensor-derived metrics and its correlation with the motor outcome in gliomas adjacent to the corticospinal tract

Abstract

Background: This study involves analysis of the relationship between variables obtained using diffusion tensor imaging (DTI) and motor outcome in gliomas adjacent to the corticospinal tract (CST). Methods: Histologically confirmed glioma patients who were to undergo surgery between January 2018 and December 2019 were prospectively enrolled. All patients had a preoperative magnetic resonance imaging (MRI) study that included DTI, a tumor 2 cm or less from the CST, and postsurgical control within 48 h. Patients with MRI that was performed at other center, tumors with primary and premotor cortex invasion, postsurgical complications directly affecting motor outcome and tumor progression <6 months were excluded in the study. In pre- and post-surgical MRI, we measured the following DTI-derived metrics: fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity of the entire CST and peritumoral CST regions and in the contralateral hemisphere. The motor outcome was assessed at 1, 3, and 6 months using the Medical Research Council scale. Results: Eleven patients were analyzed, and six corresponded to high-grade gliomas and five to low-grade gliomas. Four patients had previous motor impairment and seven patients had postsurgical motor deficits (four transient and three permanent). An FA ratio of 0.8 between peritumoral CST regions and the contralateral hemisphere was found to be the cutoff, and lower values were obtained in patients with permanent motor deficits. Conclusion: Quantitative analysis of DTI that was performed in the immediate postsurgery period can provide valuable information about the motor prognosis after surgery for gliomas near the CST.

Preserved microstructural integrity of the corticospinal tract in patients with glioma-induced motor epilepsy: a study using mean apparent propagator magnetic resonance imaging

“…Diffusion tensor imaging (DTI) is a widely used method for analyzing the effects of glioma on surrounding white matter such as the CST (8)(9)(10)(11)(12)(13)(14). Apart from the morphological characteristics of the CST, DTI also provides several diffusion indices including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD).…”

Motor outcome after resective surgery for the central lobe gliomas

“…In a recent study, Cepeda and colleagues showed that the preoperative fractional anisotropy in the peritumoral edema could be used to predict permanent deficit after surgical resection of gliomas adjacent to the corticospinal tract. [3] DTI tractography has been used recently in the intraoperative setting using augmented reality. Superimposed images in real time of the reconstructed tracts can be visualized using modern microscopes and aid in the sparing of eloquent tracts and appear to be helpful to achieve greater EOR without sacrificing functional outcomes.…”

“…In a recent study, Cepeda and colleagues showed that the preoperative fractional anisotropy in the peritumoral edema could be used to predict permanent deficit after surgical resection of gliomas adjacent to the corticospinal tract. [ 3 ]…”