Simulation of anisotropic growth of low-grade gliomas using diffusion tensor imaging

Abstract OBJECTIVE To evaluate diffusion tensor imaging (DTI)-based functional neuronavigation in surgery of cerebral gliomas with pyramidal tract (PT) involvement with respect to both perioperative assessment and follow-up outcome. METHODS A prospective, randomized controlled study was conducted between 2001 and 2005. A consecutive series of 238 eligible patients with initial imaging diagnosis of cerebral gliomas involving PTs were randomized into study (n = 118) and control (n = 120) groups. The study cases underwent DTI and three-dimensional magnetic resonance imaging scans. The maps of fractional anisotropy were calculated for PT mapping. Both three-dimensional magnetic resonance imaging data sets and fractional anisotropy maps were integrated by rigid registration, after which the tumor and adjacent PT were segmented and reconstructed for presurgical planning and intraoperative guidance. The control cases were operated on using routine neuronavigation. RESULTS There was a trend for high-grade gliomas (HGGs) in the study group to be more likely to achieve gross total resection (74.4 versus 33.3%, P < 0.001). There was no significant difference of low-grade gliomas resection between the two groups. Postoperative motor deterioration occurred in 32.8% of control cases, whereas it occurred in only 15.3% of the study cases (P < 0.001). The 6-month Karnofsky Performance Scale score of study cases was significantly higher than that of control cases (86 ± 20 versus 74 ± 28 overall, P < 0.001; 93 ± 10 versus 86 ± 17 for low-grade gliomas, P = 0.013; and 77 ± 27 versus 53 ± 32 for HGGs, P = 0.001). For 81 HGGs, the median survival of study cases was 21.2 months (95% confidence interval, 14.1–28.3 mo) compared with 14.0 months (95% confidence interval, 10.2–17.8 mo) of control cases (P = 0.048). The estimated hazard ratio for the effect of DTI-based functional neuronavigation was 0.570, representing a 43.0% reduction in the risk of death. CONCLUSION DTI-based functional neuronavigation contributes to maximal safe resection of cerebral gliomas with PT involvement, thereby decreasing postoperative motor deficits for both HGGs and low-grade gliomas while increasing high-quality survival for HGGs.

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Serial diffusion tensor imaging to characterize radiation-induced changes in normal-appearing white matter following radiotherapy in patients with adult low-grade gliomas

Radiation Medicine ◽

10.1007/s11604-007-0209-4 ◽

2008 ◽

Vol 26 (3) ◽

pp. 140-150 ◽

Cited By ~ 29

Author(s):

Mohammad Haris ◽

Shaleen Kumar ◽

Mani Karthick Raj ◽

Koilpillai Joseph Maria Das ◽

Shantanu Sapru ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Low Grade ◽

Low Grade Gliomas ◽

Normal Appearing White Matter ◽

Radiation Induced ◽

Induced Changes

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Changes in language white matter tract microarchitecture associated with cognitive deficits in patients with presumed low-grade glioma

Journal of Neurosurgery ◽

10.3171/2017.12.jns171681 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1538-1546 ◽

Cited By ~ 6

Author(s):

Fatih Incekara ◽

Djaina Satoer ◽

Evy Visch-Brink ◽

Arnaud Vincent ◽

Marion Smits

Keyword(s):

Executive Function ◽

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Low Grade Glioma ◽

Cognitive Domain ◽

Awake Surgery ◽

Low Grade ◽

Linear Regression Models

OBJECTIVEThe authors conducted a study to determine whether cognitive functioning of patients with presumed low-grade glioma is associated with white matter (WM) tract changes.METHODSThe authors included 77 patients with presumed low-grade glioma who underwent awake surgery between 2005 and 2013. Diffusion tensor imaging with deterministic tractography was performed preoperatively to identify the arcuate, inferior frontooccipital, and uncinate fasciculi and to obtain the mean fractional anisotropy (FA) and mean diffusivity per tract. All patients were evaluated preoperatively using an extensive neuropsychological protocol that included assessments of the language, memory, and attention/executive function domains. Linear regression models were used to analyze each cognitive domain and each diffusion tensor imaging metric of the 3 WM tracts.RESULTSSignificant correlations (corrected for multiple testing) were found between FA of the arcuate fasciculus and results of the repetition test for the language domain (β = 0.59, p < 0.0001) and between FA of the inferior frontooccipital fasciculus and results of the imprinting test for the memory domain (β = −0.55, p = 0.002) and the attention test for the attention and executive function domain (β = −0.62, p = 0.006).CONCLUSIONSIn patients with glioma, language deficits in repetition of speech, imprinting, and attention deficits are associated with changes in the microarchitecture of the arcuate and inferior frontooccipital fasciculi.

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Assessment of diffusion tensor imaging metrics in differentiating low-grade from high-grade gliomas

The Neuroradiology Journal ◽

10.1177/1971400916665382 ◽

2016 ◽

Vol 29 (5) ◽

pp. 400-407 ◽

Cited By ~ 50

Author(s):

Lamiaa El-Serougy ◽

Ahmed Abdel Khalek Abdel Razek ◽

Amani Ezzat ◽

Hany Eldawoody ◽

Ahmad El-Morsy

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Low Grade ◽

High Grade ◽

High Grade Gliomas

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Characterization of abnormal diffusion properties of supratentorial brain tumors: a preliminary diffusion tensor imaging study

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/4/263 ◽

2008 ◽

Vol 1 (4) ◽

pp. 263-269 ◽

Cited By ~ 23

Author(s):

Weihong Yuan ◽

Scott K. Holland ◽

Blaise V. Jones ◽

Kerry Crone ◽

Francesco T. Mangano

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Imaging Study ◽

Low Grade ◽

High Grade ◽

The Mean ◽

Supratentorial Tumors ◽

Diffusion Properties

Object Diffusion tensor (DT) imaging was used in children with supratentorial tumors to evaluate the anisotropic diffusion properties between different tumor grades and between tumors and adjacent and contralateral white matter. Methods In this retrospective review, the authors review the cases of 16 children (age range 1–18 years) who presented to their institution with supratentorial tumors and were treated between 2004 and 2007. Eleven patients had low-grade and 5 had high-grade tumors. Fractional anisotropy (FA), mean diffusivity, and axial (λ∥) and radial (λ⊥) eigenvalues within selected regions were studied. Mitotic index, necrosis, and vascularity of the tumors were compared with DT imaging parameters. Results The mean diffusivity was significantly higher in low-grade than in high-grade tumors (p = 0.04); the 2 tumor grades also significantly differed for both λ∥ (p < 0.05) and λ⊥ (p < 0.05). Mean diffusivity values in low-grade tumors were significantly higher than in adjacent normal-appearing white matter (NAWM; p = 0.0004) and contralateral NAWM (p = 0.0001). In both low- and high-grade tumors, the FA was significantly lower than in NAWM (p < 0.0001 and p < 0.03, respectively) and contralateral NAWM (p < 0.0001 and p < 0.003, respectively). Tumor cellularity highly correlated with mean diffusivity and λ∥and λ⊥. Conclusions Diffusion tensor imaging is a useful tool in the evaluation of supratentorial tumors in children. The mean diffusivity appears to be a significant marker in differentiating tumors grades. Findings related to λ∥ and λ⊥ within tumor groups and between tumors and NAWM may be an indirect manifestation of the combined effects of axonal injury, demyelination, and tumor mass within the cranial compartment.

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Strategies to maximize resection of complex, or high surgical risk, low-grade gliomas

Neurosurgical FOCUS ◽

10.3171/2012.12.focus12338 ◽

2013 ◽

Vol 34 (2) ◽

pp. E5 ◽

Cited By ~ 16

Author(s):

Jessica A. Wilden ◽

Jason Voorhies ◽

Kristine M. Mosier ◽

Darren P. O'Neill ◽

Aaron A. Cohen-Gadol

Keyword(s):

Seizure Control ◽

Diffusion Tensor ◽

Brain Mri ◽

Awake Craniotomy ◽

Low Grade ◽

Normal Brain ◽

Surgical Risk ◽

Motor Mapping ◽

Low Grade Gliomas ◽

High Surgical Risk

Object Early and aggressive resection of low-grade gliomas (LGGs) leads to increased overall patient survival, decreased malignant progression, and better seizure control. This case series describes the authors' approach to achieving optimal neurological and surgical outcomes in patients referred by outside neurosurgeons for stereotactic biopsy of tumors believed to be complex or a high surgical risk, due to their diffuse nature on neuroimaging and their obvious infiltration of functional cortex. Methods Seven patients underwent individualized neuroimaging evaluation preoperatively, which included routine brain MRI with and without contrast administration for intraoperative neuronavigation, functional MRI with speech and motor mapping, diffusion tensor imaging to delineate white matter tracts, and MR perfusion to identify potential foci of higher grade malignancy within the tumor. Awake craniotomy with intraoperative motor and speech mapping was performed in all patients. Tumor removal was initiated through a transsylvian approach for insular lesions, and through multiple corticotomies in stimulation-confirmed noneloquent areas for all other lesions. Resection was continued until neuronavigation indicated normal brain, cortical or subcortical stimulation revealed functional cortex, or the patient began to experience a minor neurological deficit on intraoperative testing. Results Gross-total resection was achieved in 1 patient and subtotal resection (> 80%) in 6 patients, as assessed by postoperative MRI. Over the average follow-up duration of 31 months, no patient experienced a progression or recurrence. Long-term seizure control was excellent in 6 patients who achieved Engel Class I outcomes. Neurologically, all 7 patients experienced mild temporary deficits or seizures that completely resolved, and 1 patient continues to have mild expressive aphasia. Conclusions Significant resection of diffuse, infiltrating LGGs is possible, even in presumed eloquent cortex. Aggressive resection maximizes seizure control and does not necessarily cause permanent neurological deficits. Individualized preoperative neuroimaging evaluation, including tractography and awake craniotomy with intraoperative speech and motor mapping, is an essential tool in achieving these outcomes.

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Diffusion tensor imaging predicts cognitive function change following partial brain radiotherapy for low-grade and benign tumors

Radiotherapy and Oncology ◽

10.1016/j.radonc.2016.06.021 ◽

2016 ◽

Vol 120 (2) ◽

pp. 234-240 ◽

Cited By ~ 30

Author(s):

Christopher H. Chapman ◽

Tong Zhu ◽

Mohamad Nazem-Zadeh ◽

Yebin Tao ◽

Henry A. Buchtel ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Cognitive Function ◽

Diffusion Tensor ◽

Benign Tumors ◽

Low Grade ◽

Brain Radiotherapy ◽

Function Change

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Diffusion Tensor Imaging Tractography for Fornix Identification in Intraventricular Tumor Surgery: A Case Series

Neurosurgery Open ◽

10.1093/neuopn/okaa005 ◽

2020 ◽

Vol 1 (3) ◽

Author(s):

Camille K Milton ◽

Ali H Palejwala ◽

Kyle P O'Connor ◽

Tressie M McCoy ◽

Andrew K Conner ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Case Series ◽

Glioneuronal Tumor ◽

Low Grade ◽

Case Examples ◽

Mixed Germ Cell Tumor ◽

Operative Memory ◽

Renal Cell Carcinoma Metastasis ◽

Dti Tractography

ABSTRACT BACKGROUND The proximity of intraventricular or periventricular tumors to critical white matter structures, such as the fornix, poses an operative challenge. In order to avoid significant neurological morbidity, deliberate selection of surgical approach is necessary when planning resection of tumors in this region. We report our initial experience with fornix modeling as an adjunct to standard navigational techniques across multiple pathologies. OBJECTIVE To report the feasibility of using diffusion tensor imaging (DTI) fornix modeling as an adjunct to standard navigational techniques for surgical treatment of intraventricular and periventricular tumors involving the fornix. METHODS Between July 2018 and August 2019, DTI tractography was performed on 12 patients with intraventricular or periventricular tumors involving the fornix. DTI fornix modeling was performed and included as part of the intraoperative navigation in all cases. RESULTS The patient group was composed of 6 males and 6 females. The fornix model was delineated in all cases using DTI tractography as described. The mean patient age was 45.7 yr. The 2 most-common tumor pathologies represented in our patient cohort included meningioma and cranipharyngioma, both found in 2 patients. A glioneuronal tumor, low-grade glioma, ependymoma, subependymoma, mixed germ-cell tumor, pituitary adenoma, and renal cell carcinoma metastasis were found in 1 patient each. Case examples of fornix modeling that may be incorporated into standard neuronavigation are presented. No patient experienced new or worsening post-operative memory deficits. CONCLUSION DTI tractography for fornix identification is a useful adjunct to standard navigational techniques employed in surgical resection of forniceal involving tumors.

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SURG-08. AWAKE CRANIOTOMY WITH BRAIN MAPPING FOR DIFFUSE LOW-GRADE GLIOMA: CASE REPORT OF INSTITUTIONAL EXPERIENCE IN OVERCOMING HURDLES IN A LOW-RESOURCE SETTING

Neuro-Oncology ◽

10.1093/neuonc/noaa215.855 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii204-ii205

Author(s):

Kirby Manigos ◽

Kevin Paul Ferraris ◽

Joseph Erroll Navarro ◽

Kenny Seng ◽

Jose Carlos Alcazaren

Keyword(s):

Brain Mapping ◽

Diffusion Tensor ◽

Low Grade Glioma ◽

Awake Craniotomy ◽

Limited Resources ◽

Low Grade ◽

Low Grade Gliomas ◽

Neurologic Deficits ◽

Weighted Sequence ◽

Low Middle Income Countries

Abstract Maximal safe resection of low-grade gliomas located in functional areas of the cortex while avoiding postsurgical neurologic deficits can be achieved by awake craniotomy with brain mapping. The effectiveness of this surgical technique is fairly established in the developed world, however it remains to be routinely applied in low-middle income countries due to limited resources and lack of equipment. We present the case of a 44 year-old, right-handed male who had a 2-year history of focal aware motor seizures but was otherwise neurologically intact. Neuropsychological testing revealed no cognitive impairment. Cranial magnetic resonance imaging (MRI) revealed a non-enhancing, ill-defined tumor centered on the left insula and extending into the frontotemporal opercula, corona radiata, and posterior limb of the internal capsule—hypointense by T1-weighted sequence and hyperintense by T2-weighted sequence, thus radiographically consistent with diffuse low-grade glioma. Blood-oxygen-level-dependent functional MRI revealed left hemispheric language dominance in the cortex overlying the tumor, but with no motor cortex involvement. The patient underwent a protocol-driven awake craniotomy, intraoperative positive brain mapping using standard cortical stimulator, transsylvian and transcortical transopercular microsurgical approaches to achieve greater than 80% excision of the tumor. Postoperatively, the patient was seizure-free and with similar neurocognitive status prior to the surgery. The patient had been following up for standard adjuvant chemotherapy and radiotherapy. Avoidance of postsurgical neurologic deficits and maximal cytoreduction can still be achieved by awake craniotomy with brain mapping in settings with limited resources. Despite the lack of other perioperative tools and adjuncts such as diffusion tensor imaging, intraoperative ultrasonography, and even intraoperative MRI that are routinely available in high-resource settings, we illustrate in this case that comparable outcomes could be achieved by overcoming hurdles and aiming for the asymptote to the up-to-date and ideal neurosurgical treatment for diffuse low-grade gliomas.

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