Cepeda Santiago, García-García Sergio, Arrese Ignacio, Velasco-Casares María, Sarabia Rosario
Department of Neurosurgery, University Hospital Río Hortega, Valladolid, Spain.
Department of Radiology, University Hospital Río Hortega, Valladolid, Spain.
Surg Neurol Int. 2021 Feb 10;12:51. doi: 10.25259/SNI_862_2020. eCollection 2021.
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).
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.
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.
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.
本研究旨在分析利用扩散张量成像（DTI）获得的变量与皮质脊髓束（CST）附近胶质瘤患者运动功能预后之间的关系。
前瞻性纳入2018年1月至2019年12月期间拟行手术治疗且经组织学确诊的胶质瘤患者。所有患者术前行磁共振成像（MRI）检查，包括DTI检查，肿瘤距CST 2 cm以内，术后48小时内进行对照检查。排除在其他中心进行MRI检查的患者、侵犯初级运动皮层和运动前区皮层的肿瘤、直接影响运动功能预后的术后并发症以及术后6个月内肿瘤进展的患者。在术前和术后MRI检查中，我们测量了以下DTI衍生指标：整个CST、瘤周CST区域以及对侧半球的分数各向异性（FA）、平均扩散率、轴向扩散率和径向扩散率。使用医学研究委员会量表在术后1、3和6个月评估运动功能预后。
共分析了11例患者，其中6例为高级别胶质瘤，5例为低级别胶质瘤。4例患者术前存在运动功能障碍，7例患者术后出现运动功能缺损（4例为短暂性，3例为永久性）。发现瘤周CST区域与对侧半球的FA比值为0.8时为临界值，永久性运动功能缺损患者的该值较低。
术后即刻进行的DTI定量分析可为CST附近胶质瘤手术后的运动功能预后提供有价值的信息。
