Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland.
Neurosurg Rev. 2022 Jun;45(3):2027-2040. doi: 10.1007/s10143-022-01759-7. Epub 2022 Feb 25.
This study aimed to systematically review the literature to determine the clinical utility and perspectives of diffusion tensor imaging (DTI) in the management of patients with brainstem cavernous malformations (BSCMs). PubMed, Embase, and Cochrane were searched for English-language articles published until May 10, 2021. Clinical studies and case series describing DTI-based evaluation of patients with BSCMs were included. Fourteen articles were included. Preoperative DTI enabled to adjust the surgical approach and choose a brainstem safe entry zone in deep-seated BSCMs. Preoperatively lower fractional anisotropy (FA) of the corticospinal tract (CST) correlated with the severity of CST injury and motor deficits. Postoperatively increased FA and decreased apparent diffusion coefficient (ADC) corresponded with the normalization of the perilesional CST, indicating motor improvement. The positive (PPV) and negative predictive value (NPV) of qualitative DTI ranged from 20 to 75% and from 66.6 to 100%, respectively. The presence of preoperative and postoperative motor deficits was associated with a higher preoperative resting motor threshold (RMT) and lower FA. A higher preoperative CST score was indicative of a lower preoperative and follow-up Medical Research Council (MRC) grade. DTI facilitated the determination of a surgical trajectory with minimized risk of WMTs' damage. Preoperative FA and RMT might indicate the severity of preoperative and postoperative motor deficits. Preoperative CST score can reliably reflect patients' preoperative and follow-up motor status. Due to high NPV, normal CST morphology might predict intact neurological outcomes. Contrarily, sparse and relatively low PPV limits the reliable prediction of neurological deficits.
本研究旨在系统地回顾文献，以确定弥散张量成像（DTI）在脑干海绵状畸形（BSCM）患者管理中的临床应用和观点。检索了 PubMed、Embase 和 Cochrane 数据库中截至 2021 年 5 月 10 日发表的英文文献。纳入了描述基于 DTI 评估 BSCM 患者的临床研究和病例系列。共纳入 14 篇文章。术前 DTI 可调整深部 BSCM 的手术入路和选择脑干安全进入区。术前皮质脊髓束（CST）的分数各向异性（FA）较低与 CST 损伤和运动功能障碍的严重程度相关。术后 FA 增加和表观扩散系数（ADC）降低与病变周围 CST 的正常化相对应，表明运动功能改善。定性 DTI 的阳性（PPV）和阴性预测值（NPV）分别为 20%至 75%和 66.6%至 100%。术前和术后运动功能障碍的存在与较高的术前静息运动阈值（RMT）和较低的 FA 相关。术前 CST 评分较低提示术前和随访的 Medical Research Council（MRC）分级较低。DTI 有助于确定具有最小 WMT 损伤风险的手术轨迹。术前 FA 和 RMT 可能提示术前和术后运动功能障碍的严重程度。术前 CST 评分可可靠反映患者术前和随访的运动状态。由于 NPV 较高，正常 CST 形态可能预测神经功能结局完好。相反，稀疏且相对较低的 PPV 限制了对神经功能缺损的可靠预测。
