Tomasino Barbara, Baiano Cinzia, Ricciardi Giuseppe Kenneth, Maieron Marta, Romano Andrea, Guarracino Ilaria, Isola Miriam, De Martino Maria, D'Agostini Serena, Bagatto Daniele, Somma Teresa, Skrap Miran, Ius Tamara
Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, 33037 Pasian di Prato, Italy.
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80138 Napoli, Italy.
Curr Oncol. 2024 Dec 20;31(12):8075-8093. doi: 10.3390/curroncol31120595.
Tractography allows the in vivo study of subcortical white matter, and it is a potential tool for providing predictive indices on post-operative outcomes. We aim at establishing whether there is a relation between cognitive outcome and the status of the inferior fronto-occipital fasciculus's (IFOF's) microstructure.
The longitudinal neuropsychological data of thirty young (median age: 35 years) patients operated on for DLGG in the left temporo-insular cortex along with pre-surgery tractography data were processed.
A degraded integrity of the left (vs. right) IFOF (lower fractional anisotropy and length, < 0.001; higher mean and axial diffusivity, < 0.01) was found, with lower microstructural variables in the infiltration (vs. dislocation) group. Significant decreases immediately post-surgery vs. pre-surgery mainly occurred in lexico-semantics ( < 0.001), with significant improvements at follow-up in all the tests ( < 0.01 to < 0.001), despite values in the range of 44% to 47.82% of patients with below cut-off scores regarding naming verbs and making visual lexical decisions. The status of left and right IFOFs is predictive of a decrease in immediate post-surgery performance for several tests ( < 0.05); similarly, it is predictive of better recovery in the follow-up performance for naming nouns, naming verbs, making phonological fluency lexical decisions, and the token test ( < -0.05). For the ROC analysis, a significant result was obtained for the verb-naming test, with a cut-off of 79%.
This study supports the role of the predictive value of pre-operative tractography for assessing the immediate post-operative result and at follow-up the risk of developing a cognitive deficit.
纤维束成像技术可用于活体研究皮质下白质，是一种为术后结果提供预测指标的潜在工具。我们旨在确定认知结果与额枕下束（IFOF）微观结构状态之间是否存在关联。
对30名年轻（中位年龄：35岁）患者进行了处理，这些患者因左侧颞岛叶皮质的弥漫性低级别胶质瘤（DLGG）接受手术，并收集了术前纤维束成像数据以及纵向神经心理学数据。
发现左侧（相对于右侧）IFOF的完整性下降（分数各向异性和长度较低，<0.001；平均扩散率和轴向扩散率较高，<0.01），浸润（相对于脱位）组的微观结构变量较低。与术前相比，术后立即出现的显著下降主要发生在词汇语义方面（<0.001），尽管在命名动词和进行视觉词汇决策方面得分低于临界值的患者比例在44%至47.82%之间，但在所有测试中随访时均有显著改善（<0.01至<0.001）。左右IFOF的状态可预测多项测试术后立即表现的下降（<0.05）；同样，它可预测在随访中名词命名、动词命名、进行语音流畅性词汇决策和代币测试的恢复情况更好（<-0.05）。对于ROC分析，动词命名测试获得了显著结果，临界值为79%。
本研究支持术前纤维束成像在评估术后即刻结果以及随访时发生认知缺陷风险方面具有预测价值的作用。
