Lenga Pavlina, Scherer Moritz, Peretzke Robin, Neher Peter, Jesser Jessica, Unterberg Andreas W, Krieg Sandro, Becker Daniela
Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
Medical Faculty of Heidelberg University, Heidelberg, Germany.
Brain Spine. 2024 Nov 14;4:104139. doi: 10.1016/j.bas.2024.104139. eCollection 2024.
After resection of eloquent gliomas, impacting motor pathways, patients frequently harbour pronounced motor deficits (MD), predominantly attributed to damage to the corticospinal tract (CST).
This study compares the results of conventional DTI-FT and q-ball (QBI)-high resolution FT with patient's postoperative morbidity, relating postoperative MD with the nearest distance from the lesion to the CST (nD-LCST).
In this ongoing prospective trial, we utilized probabilistic High-Resolution Fiber Tracking (HRFT) through q-ball imaging (QBI-FT) and conventional Diffusion Tensor Imaging Fiber Tracking (DTI-FT), based on equal and standard diffusion-weighted MRI. Our analysis focused on the normalized Distance from the lesion to the CST-FT (nD-LCST), compared with MD evaluated via standardized clinical examination.
Post-surgery, 4 patients developed new MD or deteriorated respectively. Among these, one patient was diagnosed with glioblastoma, one with diffuse astrocytoma, one with anaplastic astrocytoma, and one with oligodendroglioma. QBI-FT analysis revealed that patients with MD had a significantly lower median nD-LCST (-0.4 IQR = 2.1), in contrast to those without MD (8.4 IQR = 3.9; p = 0.029). Median values of QBI-FT were located within the tumor outlines, when MD deteriorated. Patients with postoperatively impaired MD had larger tumor volumes compared to those without MD.
Our preliminary findings suggest that QBI-FT may offer advantages over DTI-FT in predicting postoperative motor deficits, potentially enhancing neurosurgical planning. However, due to the small sample size of our study, these results are exploratory, and further research with larger patient populations is necessary to confirm the benefits of QBI-FT. QBI-FT shows promise as a complementary tractography technique suitable for clinical purposes alongside standard DTI-FT.
在切除影响运动通路的明确胶质瘤后，患者常伴有明显的运动功能缺损（MD），主要归因于皮质脊髓束（CST）受损。
本研究比较了传统扩散张量成像纤维束示踪（DTI-FT）和q球成像（QBI）-高分辨率纤维束示踪与患者术后发病率的结果，将术后MD与病变到CST的最近距离（nD-LCST）相关联。
在这项正在进行的前瞻性试验中，我们基于同等和标准的扩散加权磁共振成像，通过q球成像（QBI-FT）和传统扩散张量成像纤维束示踪（DTI-FT）进行概率性高分辨率纤维束示踪（HRFT）。我们的分析重点是病变到CST-FT的标准化距离（nD-LCST），并与通过标准化临床检查评估的MD进行比较。
术后，4例患者分别出现了新的MD或病情恶化。其中，1例患者被诊断为胶质母细胞瘤，1例为弥漫性星形细胞瘤，1例为间变性星形细胞瘤，1例为少突胶质细胞瘤。QBI-FT分析显示，与无MD的患者相比，有MD的患者nD-LCST中位数显著更低（-0.4，四分位间距=2.1），而无MD的患者为8.4（四分位间距=3.9；p=0.029）。当MD恶化时，QBI-FT的中位数位于肿瘤轮廓内。与无MD的患者相比，术后MD受损的患者肿瘤体积更大。
我们的初步研究结果表明，在预测术后运动功能缺损方面，QBI-FT可能比DTI-FT更具优势，有可能改善神经外科手术规划。然而，由于我们研究的样本量较小，这些结果具有探索性，需要对更大的患者群体进行进一步研究以证实QBI-FT的益处。QBI-FT有望作为一种与标准DTI-FT互补的纤维束示踪技术用于临床。
