Role of diffusion tensor magnetic resonance tractography in predicting the extent of resection in glioma surgery

Abstract

Diffusion tensor imaging (DTI) tractography enables the in vivo visualization of the course of white matter tracts inside or around a tumor, and it provides the surgeon with important information in resection planning. This study is aimed at assessing the ability of preoperative DTI tractography in predicting the extent of the resection achievable in surgical removal of gliomas. Patients with low-grade gliomas (LGGs; 46) and high-grade gliomas (HGGs; 27) were studied using a 3T scanner according to a protocol including a morphological study (T2, fluid-attenuated inversion-recovery, T1 sequences) and DTI acquisitions (b = 1000 s/mm(2), 32 gradient directions). Preoperative tractography was performed off-line on the basis of a streamline algorithm, by reconstructing the inferior fronto-occipital (IFO), the superior longitudinal fascicle (SLF), and the corticospinal tract (CST). For each patient, the relationship between each bundle reconstructed and the lesion was analyzed. Initial and residual tumor volumes were measured on preoperative and postoperative 3D fluid-attenuated inversion-recovery images for LGGs and postcontrast T1-weighted scans for HGGs. The presence of intact fascicles was predictive of a better surgical outcome, because these cases showed a higher probability of total resection than did subtotal and partial resection. The presence of infiltrated or displaced CST or infiltrated IFO was predictive of a lower probability of total resection, especially for tumors with preoperative volume <100 cm(3). DTI tractography can thus be considered to be a promising tool for estimating preoperatively the degree of radicality to be reached by surgical resection. This information will aid clinicians in identifying patients who will mostly benefit from surgery.

Quantification of Corticospinal Tracts with Diffusion Tensor Imaging in Brainstem Surgery: Prognostic Value in 14 Consecutive Cases at 3T Magnetic Resonance Imaging

“…To date, this has been reported mostly in supratentorial tumor surgery (18,36). Previous studies have reported that for supratentorial lesions, preoperative CST involvement may be a predictor of motor deficit and that postoperative improvement, or normalization, of the CST was a predictor of clinical improvement (3,4,9).…”

Subcortical anatomy as an anatomical and functional landmark in insulo-opercular gliomas: implications for surgical approach to the insular region

“…Intraoperative brain mapping studies have recently demonstrated that DTI tractography data are accurate to describe the trajectory of tracts when infiltrated by tumor, as tracking results correlated with those obtained by direct electrical stimulation. 2,4 Consequently, the complete disruption of the tract may predict the absence of eloquent subcortical areas, increasing the likelihood of a greater resection. In the case presented in Fig.…”

Advances in Magnetic Resonance Imaging and Positron Emission Tomography Imaging for Grading and Molecular Characterization of Glioma

“…In this study, it was found that patients with intact white matter fiber tracts or fascicles on DTI had a higher likelihood of complete resection compared with patients with infiltrated or displaced fascicles. [51] Functional mapping for patients with low-grade gliomas in suspected eloquent regions of the brain has also been suggested as a tool to improve delineation of true functional and non-functional areas to maximize tumor resection while maintaining function. [52] In addition to multiparametric MRI, several groups have demonstrated the utility of MET PET in guiding surgery and radiation treatment planning of brain tumors.…”