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

Santiago Cepeda, Sergio García-García, Ignacio Arrese, María Velasco-Casares, Rosario Sarabia, Santiago Cepeda, Sergio García-García, Ignacio Arrese, María Velasco-Casares, Rosario Sarabia

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.

Keywords: Corticospinal tract; Diffusion tensor imaging; Fiber tracking; Glioma; Motor outcome.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Surgical Neurology International.

Figures

Fig 1:
Fig 1:
Example of the methodology used for fiber tracking. (a) Three-dimensional visualization of CST tracts (ipsitumoral and healthy) along with the tumor and regions of interest (ROIs) that were used. Axial slices of diffusion tensor imaging-based color map showing ROI for the midbrain (b), posterior limb of internal capsule (c), and primary motor cortex (d).
Fig 2:
Fig 2:
Illustrative case showing the methodology that was used to determine the peritumoral corticospinal tract (CST) region. (a) Preoperative diffusion tensor imaging (DTI) color map (left) and T1-weighted postcontrast (right) axial images showing a high grade glioma adjacent to CST. ROI is placed over the area corresponding to the CST, as determined by the color fiber direction. A second ROI is placed in the contralateral hemisphere. (b) Postoperative DTI color map (left) and T1-weighted postcontrast (right) axial images. The ipsilateral ROI is placed in the CST region that is adjacent to the postsurgical cavity; a second ROI is placed in the contralateral CST region in the healthy hemisphere.
Figure 3:
Figure 3:
Illustrative cases of permanent motor deficits. From left to right: preoperative T1-weighted postcontrast and postoperative images: T1-weighted postcontrast, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) map. The location of the pyramidal tract that was determined by fiber tracking is also shown (white asterisk). (a) A 53-year-old man with a parieto-temporal glioblastoma; (b) a 65-year-old man with a right frontal glioblastoma; and (c) a 54-year-old man with a right temporo-insular glioblastoma.
Figure 4:
Figure 4:
Box plots showing differences in the peritumoral diffusion tensor imaging-derived metrics according to the type of postoperative motor deficit. (a) Peritumoral fractional anisotropy (FA); (b) peritumoral mean diffusivity; (c) peritumoral radial diffusivity; and (d)p FA ratio (rFA; affected/unaffected).
Figure 5:
Figure 5:
Graphic output of cutoff determination using the Youden index. (a) Metric values by the optimal criterion. (b) Cutoff point for peritumoral FA ratio (rFA; affected/unaffected). AUC: Area under the curve.

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