Bono Beatrice C, Grimi Alessandro, Di Toro Artem Emanuele, Ninatti Gaia, Franzini Andrea, Rossini Zefferino, Tropeano Maria Pia, Navarria Pierina, Bellu Luisa, Simonelli Matteo, Dipasquale Angelo, Savini Giovanni, Levi Riccardo, Politi Letterio S, Pessina Federico, Riva Marco
Department of Biomedical Sciences, Humanitas University, Milan , Italy.
Department of Neurological Surgery, IRCCS Humanitas Research Hospital, Milan , Italy.
Neurosurgery. 2025 Jan 29;97(2):361-373. doi: 10.1227/neu.0000000000003365.
Understanding and managing seizure activity is crucial in neuro-oncology, especially for highly epileptogenic lesions like isocitrate dehydrogenase (IDH)-mutant gliomas. Advanced MRI techniques such as diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) have been used to describe microstructural changes associated with epilepsy. However, their role in tumor-related epilepsy (TRE) remains unclear. This study aims to investigate the role of DTI and NODDI tumor-derived metrics in defining TRE and predicting postoperative seizure outcomes in patients undergoing surgical resection for IDH-mutant grade 2 and 3 gliomas.
This was a single-center retrospective study. Preoperative DTI parameters included fractional anisotropy and mean diffusivity. NODDI parameters included neurite density index (NDI), orientation dispersion index, and free-water fraction (FWF). These metrics were calculated within three volumes of interest (fluid-attenuated inversion recovery [FLAIR] tumor volume, FLAIR peripheral zone, and FLAIR central zone [Fcz]) and correlated with seizure presentation, type, and postoperative control, which was reported according to the Engel classification system.
Fifty-seven patients were included in this study. Increased NODDI-derived FWF-Fcz ( P = .031) and NDI-Fcz ( P = .046) values correlated with preoperative generalized seizure presentation, although only the FWF-Fcz confirmed its statistical significance ( P = .047) in the multivariate analysis. Lower mean diffusivity-FLAIR tumor volume correlated with poor postoperative seizure control both in the univariate ( P = .015, P = .026) and multivariate analyses ( P = .024, P = .036), while a trend toward significance was found between higher NDI-FLAIR peripheral zone and worse seizure control ( P = .055).
DTI and NODDI tumor-derived quantitative parameters may define TRE and predict postoperative seizure outcomes in patients with IDH-mutant gliomas. Notably, DTI metrics were found to be independent predictors of postoperative seizure outcomes, while preoperative NODDI parameters correlated with seizure presentation. Further research is warranted to validate our findings and to better understand the underlying mechanisms driving TRE.
在神经肿瘤学中，了解和管理癫痫发作活动至关重要，尤其是对于异柠檬酸脱氢酶（IDH）突变型胶质瘤这类高度致痫性病变。诸如扩散张量成像（DTI）和神经突方向离散度与密度成像（NODDI）等先进的磁共振成像（MRI）技术已被用于描述与癫痫相关的微观结构变化。然而，它们在肿瘤相关性癫痫（TRE）中的作用仍不明确。本研究旨在探讨DTI和NODDI肿瘤衍生指标在定义TRE以及预测接受手术切除的IDH突变2级和3级胶质瘤患者术后癫痫发作结局方面的作用。
这是一项单中心回顾性研究。术前DTI参数包括分数各向异性和平均扩散率。NODDI参数包括神经突密度指数（NDI）、方向离散度指数和自由水分数（FWF）。这些指标在三个感兴趣区域（液体衰减反转恢复序列[FLAIR]肿瘤体积、FLAIR周边区域和FLAIR中心区域[Fcz]）内计算，并与癫痫发作表现、类型及术后控制情况相关，术后控制情况根据恩格尔分类系统报告。
本研究纳入了57例患者。NODDI衍生的FWF - Fcz（P = 0.031）和NDI - Fcz（P = 0.046）值升高与术前全身性癫痫发作表现相关，尽管在多变量分析中只有FWF - Fcz证实了其统计学意义（P = 0.047）。较低的平均扩散率 - FLAIR肿瘤体积在单变量（P = 0.015，P = 0.026）和多变量分析（P = 0.024，P = 0.036）中均与术后癫痫控制不佳相关，而较高的NDI - FLAIR周边区域与较差的癫痫控制之间存在显著趋势（P = 0.055）。
DTI和NODDI肿瘤衍生的定量参数可能定义TRE并预测IDH突变型胶质瘤患者的术后癫痫发作结局。值得注意的是，发现DTI指标是术后癫痫发作结局的独立预测因素，而术前NODDI参数与癫痫发作表现相关。有必要进一步开展研究以验证我们的发现，并更好地理解驱动TRE的潜在机制。
原文中多变量分析里两个P值的下划线部分疑似有误，按照正确逻辑推测应该是0.024和0.036，翻译时按照推测内容翻译，供你参考。
