The Utilization of Diffusion Tensor Imaging as an Image-Guided Tool in Brain Tumor Resection Surgery: A Systematic Review

Abstract

The diffusion tensor imaging technique has been recognized as a neuroimaging tool for in vivo visualization of white matter tracts. However, DTI is not a routine procedure for preoperative planning for brain tumor resection. Our study aimed to systematically evaluate the effectiveness of DTI and the outcomes of surgery. The electronic databases, PubMed/MEDLINE and Scopus, were searched for relevant studies. Studies were systematically reviewed based on the application of DTI in pre-surgical planning, modification of operative planning, re-evaluation of preoperative DTI data intraoperatively, and the outcome of surgery decisions. Seventeen studies were selected based on the inclusion and exclusion criteria. Most studies agreed that preoperative planning using DTI improves postoperative neuro-deficits, giving a greater resection yield and shortening the surgery time. The results also indicate that the re-evaluation of preoperative DTI intraoperatively assists in a better visualization of white matter tract shifts. Seven studies also suggested that DTI modified the surgical decision of the initial surgical approach and the rate of the GTR in tumor resection surgery. The utilization of DTI may give essential information on white matter tract pathways, for a better surgical approach, and eventually reduce the risk of neurologic deficits after surgery.

Predictive Value of Preoperative Diffusion Tensor Imaging for Evaluating Postoperative Outcomes of Supratentorial Glioma in the Motor Function Area

“…Multimodal techniques, including functional MR, neuronavigation, intraoperative MRI, and intraoperative electrophysiological monitoring, are increasingly being used in clinical practice to improve the safety of maximal brain tumor resection. 7,[16][17][18][19] DTI is the only noninvasive tool for in vivo assessment of the anatomy, architecture, and microstructure of white matter tracts, as well as areas pathologically altered by the tumor, especially eloquent areas. 14 In our study, the common preoperative neurological symptoms of supratentorial glioma included muscle weakness, epilepsy, speech disorder, and visual impairment.…”

“…Secondly, the displacement of the white matter tract can be changed during surgery due to gravity, the patient's head position, surgical equipment, edema, or loss of brain parenchyma. 7 Therefore, the position of the fiber tract in DTI may be altered, thereby reducing the reliability of preoperative DTI and intraoperative neurolocalization systems. 25 The lack of postoperative DTI data is another limitation of this study.…”

“…5,6 Therefore, it is crucial to localize white matter fiber tracts and preoperatively determine their anatomical relationship with the tumor to ensure maximal resection and reduce the risk of postoperative neurological deficits. 7 Diffusion tensor imaging (DTI) is a noninvasive advanced magnetic resonance technique that determines the orientation and location of white matter fiber tracts on different planes based on anisotropic diffusion of water molecules in axons. Furthermore, analysis of the fractional anisotropy (FA) map and the color-coded orientation map helps to evaluate the characteristics and different patterns of glioma infiltration into the adjacent fiber tracts, including deviation, edema, infiltration, and destruction of tracts.…”

“…8 Studies have shown the value of preoperative DTI for surgical planning, changing surgical modality, and predicting surgical outcomes. 5,[7][8][9][10][11] However, some studies have shown that DTI does not significantly alter the surgical strategy. 10,12 Therefore, we conducted this study to evaluate the utility of preoperative DTI in surgical planning, assessing tumor characteristics, and predicting the risk factors of operative treatment outcomes of supratentorial gliomas in the motor function area.…”

Effects of 3-month CPAP therapy on brain structure in obstructive sleep apnea: A diffusion tensor imaging study

“…DTI can analyze the dispersion movement of water molecules in tissues in three-dimensional space and non-invasively observe the changes in WM structure and fiber bundles in the brain ( 15 ), which is used to study the pathophysiological changes in the early brain ( 16 ). Based on the advantages of voxel and trajectory analysis, tract-based spatial statistics (TBSS) has been widely applied in studies of various neurological diseases, such as Parkinson's disease ( 17 ), chronic spinal cord injury in children ( 18 ), multiple sclerosis ( 19 ), schizophrenia ( 20 ), and preoperative evaluation of tumor ( 21 ). Macey et al ( 22 ) showed that OSA is more likely to damage WM fibers (bilateral cingulate, right terminal striatum) in women, and this differential damage helps explain the sex differences in symptoms, particularly anxiety and depression.…”