White Matter Integrity of the Corticospinal Tract for Estimation of Individual Patient Risk for Postoperative Neurological Deterioration after Glioma Surgery

Abstract

Background: Tractography has become a standard tool for planning neurosurgical operations and has been proven to be useful for risk stratification. In various conditions, tractography-derived white matter integrity has been shown to be associated with neurological outcome. Postoperative performance has been shown to be a prognostic marker in glioma. We aimed to assess the relation of preoperative corticospinal tract (CST) integrity with postoperative neurological deterioration in patients with malignant glioma. Methods: We retrospectively analyzed a cohort of 24 right-handed patients (41.7% female) for perioperative neurological performance score (NPS) and applied our anatomical tractography workflow to extract the median fractional anisotropy (FA) of the CST in preoperative magnetic resonance imaging (MRI). Results: Median FA of the CST ipsilateral to the tumor correlated significantly with preoperative NPS (p = 0.025). After rank order correlation and multivariate linear regression, we found that the preoperative median FA of the right CST correlates with preoperative NPS, independently from epidemiological data (p = 0.019). In patients with lesions of the right hemisphere, median FA of the right CST was associated with a declining NPS in multivariate linear regression (p = 0.024). Receiver operating characteristic (ROC) analysis revealed an optimal FA cutoff at 0.3946 in this subgroup (area under the curve 0.83). Patients below that cutoff suffered from a decline in neurological performance significantly more often (p = 0.020). Conclusions: Assessment of preoperative white matter integrity may be a promising biomarker for risk estimation of patients undergoing craniotomy for resection of malignant glioma.

Radiomic white matter parameters of functional integrity of the corticospinal tract in high-grade glioma

“…The data was preprocessed with the dwipreproc 23 command in MRtrix3 ( www.mrtrix.org ) 24 including eddy correction and underwent a visual quality check. CST tractography was performed first manually with MRtrix3 17 , and also automatically in TractSeg. 15 Tractography parameters included an FA cutoff of 0.15, a maximum length of 250 mm, a minimum length of 60 mm, and 10 6 seeds.…”

“…While a great number of connectomic studies use streamline count or its derivates to measure structural connectivity, its biological relevance has not yet been proven 16 . On the other hand, diffusion measures like the mean FA of voxels in a tract volume have been shown to relate to outcome and function [17][18][19] .…”