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Tractography-guided surgery of brain tumours: what is the best method to outline the corticospinal tract?
, 2, 3, 1, 3, 1, 4, 4
Affiliations- Neurosurgery Department, Medical University of Gdansk, Debinki 7, 81-952 Gdańsk, Poland
- University Hospital Collegium Medicum Nicolaus Copernicus University, Ujejskiego 75, Bydgoszcz, Poland
- Student’s Scientific Circle, Neurosurgery Department, Medical University of Gdańsk, Debinki 7, 81-952 Gdańsk, Poland
- Radiology Department, Medical University of Gdansk, Debinki 7, 81-952 Gdańsk, Poland
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Abstract
Background: Diffusion tensor imaging (DTI) is the imaging technique used in vivo to visualise white matter pathways. The cortico-spinal tract (CST) belongs to one of the most often delineated tracts preoperatively, although the optimal DTI method has not been established yet. Considering that various regions of interests (ROIs) could be selected, the reproducibility of CST tracking among different centres is low. We aimed to select the most reliable tractography method for outlining the CST for neurosurgeons.
Materials and methods: Our prospective study consisted of 32 patients (11 males, 21 females) with a brain tumour of various locations. DTI and T1-weighed image series were acquired prior to the surgery. To draw the CST, the posterior limb of the internal capsule (PLIC) and the cerebral peduncle (CP) were defined as two main ROIs. Together with these main ROIs, another four cortical endpoints were selected: the frontal lobe (FL), the supplementary motor area (SMA), the precentral gyrus (PCG) and the postcentral gyrus (POCG). Based on these ROIs, we composed ten virtual CSTs in DSI Studio. The fractional anisotropy, the mean diffusivity, the tracts’ volume, the length and the number were compared between all the CSTs. The degree of the CST infiltration, tumour size, the patients’ sex and age were examined.
Results: Significant differences in the number of tracts and their volume were observed when the PLIC or the CP stood as a single ROI comparing with the two- ROI method (all p < 0.05). The mean CST volume was 40054U (SD ± 12874) and the number of fibres was 259.3 (SD ± 87.3) when the PLIC was a single ROI. When the CP was a single ROI, almost a half of fibres (147.6; SD ± 64.0) and half of the CST volume (26664U; SD ± 10059U) was obtained (all p < 0.05). There were no differences between the various CSTs in terms of fractional anisotropy, mean diffusivity, the apparent diffusion coefficient, radial diffusivity and the tract length (p > 0.05). The CST was infiltrated by a growing tumour or oedema in 17 of 32 patients; in these cases, the mean and apparent diffusion of the infiltrated CST was significantly higher than in uncompromised CSTs (p = 0.04). CST infiltration did not alter the other analysed parameters (all p > 0.05).
Conclusions: A universal method of DTI of the CST was not developed. However, we found that the CP or the PLIC (with or without FL as the second ROI) should be used to outline the CST.
Abstract
Background: Diffusion tensor imaging (DTI) is the imaging technique used in vivo to visualise white matter pathways. The cortico-spinal tract (CST) belongs to one of the most often delineated tracts preoperatively, although the optimal DTI method has not been established yet. Considering that various regions of interests (ROIs) could be selected, the reproducibility of CST tracking among different centres is low. We aimed to select the most reliable tractography method for outlining the CST for neurosurgeons.
Materials and methods: Our prospective study consisted of 32 patients (11 males, 21 females) with a brain tumour of various locations. DTI and T1-weighed image series were acquired prior to the surgery. To draw the CST, the posterior limb of the internal capsule (PLIC) and the cerebral peduncle (CP) were defined as two main ROIs. Together with these main ROIs, another four cortical endpoints were selected: the frontal lobe (FL), the supplementary motor area (SMA), the precentral gyrus (PCG) and the postcentral gyrus (POCG). Based on these ROIs, we composed ten virtual CSTs in DSI Studio. The fractional anisotropy, the mean diffusivity, the tracts’ volume, the length and the number were compared between all the CSTs. The degree of the CST infiltration, tumour size, the patients’ sex and age were examined.
Results: Significant differences in the number of tracts and their volume were observed when the PLIC or the CP stood as a single ROI comparing with the two- ROI method (all p < 0.05). The mean CST volume was 40054U (SD ± 12874) and the number of fibres was 259.3 (SD ± 87.3) when the PLIC was a single ROI. When the CP was a single ROI, almost a half of fibres (147.6; SD ± 64.0) and half of the CST volume (26664U; SD ± 10059U) was obtained (all p < 0.05). There were no differences between the various CSTs in terms of fractional anisotropy, mean diffusivity, the apparent diffusion coefficient, radial diffusivity and the tract length (p > 0.05). The CST was infiltrated by a growing tumour or oedema in 17 of 32 patients; in these cases, the mean and apparent diffusion of the infiltrated CST was significantly higher than in uncompromised CSTs (p = 0.04). CST infiltration did not alter the other analysed parameters (all p > 0.05).
Conclusions: A universal method of DTI of the CST was not developed. However, we found that the CP or the PLIC (with or without FL as the second ROI) should be used to outline the CST.
Keywords
diffusion tensor imaging, diffusion tensor tractography, tractography, corticospinal tract, pyramidal tract, glioma surgery, neurosurgery
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About this articleTitle
Tractography-guided surgery of brain tumours: what is the best method to outline the corticospinal tract?
Journal
Issue
Article type
Original article
Pages
40-46
Published online
2020-02-13
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1914
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1806
DOI
Pubmed
Bibliographic record
Folia Morphol 2021;80(1):40-46.
Keywords
diffusion tensor imaging
diffusion tensor tractography
tractography
corticospinal tract
pyramidal tract
glioma surgery
neurosurgery
Authors
T. Szmuda
S. Kierońska
S. Ali
P. Słoniewski
M. Pacholski
J. Dzierżanowski
A. Sabisz
E. Szurowska
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