Neuroradiology Unit and CERMAC, Scientific Institute and Università Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
Neuro Oncol. 2012 Feb;14(2):192-202. doi: 10.1093/neuonc/nor188. Epub 2011 Oct 20.
Diffusion tensor imaging (DTI) tractography enables the in vivo visualization of the course of white matter tracts inside or around a tumor, and it provides the surgeon with important information in resection planning. This study is aimed at assessing the ability of preoperative DTI tractography in predicting the extent of the resection achievable in surgical removal of gliomas. Patients with low-grade gliomas (LGGs; 46) and high-grade gliomas (HGGs; 27) were studied using a 3T scanner according to a protocol including a morphological study (T2, fluid-attenuated inversion-recovery, T1 sequences) and DTI acquisitions (b = 1000 s/mm(2), 32 gradient directions). Preoperative tractography was performed off-line on the basis of a streamline algorithm, by reconstructing the inferior fronto-occipital (IFO), the superior longitudinal fascicle (SLF), and the corticospinal tract (CST). For each patient, the relationship between each bundle reconstructed and the lesion was analyzed. Initial and residual tumor volumes were measured on preoperative and postoperative 3D fluid-attenuated inversion-recovery images for LGGs and postcontrast T1-weighted scans for HGGs. The presence of intact fascicles was predictive of a better surgical outcome, because these cases showed a higher probability of total resection than did subtotal and partial resection. The presence of infiltrated or displaced CST or infiltrated IFO was predictive of a lower probability of total resection, especially for tumors with preoperative volume <100 cm(3). DTI tractography can thus be considered to be a promising tool for estimating preoperatively the degree of radicality to be reached by surgical resection. This information will aid clinicians in identifying patients who will mostly benefit from surgery.
弥散张量成像（DTI）纤维束示踪技术可实现肿瘤内或周围白质束的活体可视化，并为外科医生提供切除计划中的重要信息。本研究旨在评估术前 DTI 纤维束示踪术在预测胶质瘤切除范围中的作用。对 46 例低级别胶质瘤（LGG）和 27 例高级别胶质瘤（HGG）患者使用 3T 扫描仪进行研究，采用包括形态学研究（T2、液体衰减反转恢复、T1 序列）和 DTI 采集（b = 1000 s/mm2，32 个梯度方向）的方案。根据基于示踪算法的流线算法离线进行术前纤维束示踪，重建下额枕束（IFO）、上纵束（SLF）和皮质脊髓束（CST）。对每个患者，分析重建的每个束与病变之间的关系。LGG 患者基于术前和术后 3D 液体衰减反转恢复图像，HGG 患者基于增强 T1 加权扫描，对初始和残余肿瘤体积进行测量。完整束的存在预测手术结果更好，因为这些病例比次全切除和部分切除具有更高的全切除可能性。CST 受侵或移位或 IFO 受侵的存在预测全切除的可能性降低，特别是对于术前体积<100 cm3 的肿瘤。因此，DTI 纤维束示踪术可被视为术前估计手术切除范围的一种很有前途的工具。该信息将有助于临床医生识别最受益于手术的患者。
