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Elliott A, Villemoes E, Farhat M, Klingberg E, Langshaw H, Svensson S, Chung C. Development and benchmarking diffusion magnetic resonance imaging analysis for integration into radiation treatment planning. Med Phys 2024; 51:2108-2118. [PMID: 37633837 DOI: 10.1002/mp.16670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 02/20/2023] [Accepted: 04/28/2023] [Indexed: 08/28/2023] Open
Abstract
PURPOSE The rising promise in the utility of advanced multi-parametric magnetic resonance (MR) imaging in radiotherapy (RT) treatment planning creates a necessity for testing and enhancing the accuracy of quantitative imaging analysis. Standardizing the analysis of diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) to generate meaningful and reproducible apparent diffusion coefficient (ADC) and fractional anisotropy (FA) lays the requisite needed for clinical integration. The aim of the demonstrated work is to benchmark the generation of the ADC and FA parametric map analyses using integrated tools in a commercial treatment planning system against the currently used ones. METHODS Three software packages were used for generating ADC and FA maps in this study; one tool was developed within a commercial treatment planning system, another by the Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library FSL (Analysis Group, FMRIB, Oxford, United Kingdom), and an in-house tool developed at the M.D. Anderson Cancer Center. The ADC and FA maps generated by all three packages for 35 subjects were subtracted from one another, and the standard deviation of the images' differences was used to compare the reproducibility. The reproducibility of the ADC maps was compared with the Quantitative Imaging Biomarkers Alliance (QIBA) protocol, while that of the FA maps was compared to data in published literature. RESULTS Results show that the discrepancies between the ADC maps calculated for each patient using the three different software algorithms are less than 2% which meets the 3.6% recommended QIBA requirement. Except for a small number of isolated points, the majority of differences in FA maps for each patient produced by the three methods did not exceed 0.02 which is 10 times lower than the differences seen in healthy gray and white matter. The results were also compared to the maps generated by existing MR Imaging consoles and showed that the robustness of console generated ADC and FA maps is largely dependent on the correct application of scaling factors, that only if correctly placed; the differences between the three tested methods and the console generated values were within the recommended QIBA guidelines. CONCLUSIONS Cross-comparison difference maps demonstrated that quantitative reproducibility of ADC and FA metrics generated using our tested commercial treatment planning system were comparable to in-house and established tools as benchmarks. This integrated approach facilitates the clinical utility of diffusion imaging in radiation treatment planning workflow.
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Affiliation(s)
- Andrew Elliott
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Maguy Farhat
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Holly Langshaw
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Caroline Chung
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Takeuchi K. Endoscopic Cylinder Surgery for Ventricular Lesions. Adv Tech Stand Neurosurg 2024; 52:91-104. [PMID: 39017788 DOI: 10.1007/978-3-031-61925-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Cylinder retractors have been developed to reduce the risk of brain retraction injury during surgery by dispersing retraction pressure on the brain. In recent years, various types of cylinder retractors have been developed and widely used in neurosurgery. The ventricles, being deep structures within the brain, present an effective area for cylinder retractor utilization. Endoscopy provides a bright, wide field of view in the deep surgical field, even through narrow corridors.This chapter introduces surgical techniques using an endoscope through a cylinder. Given the deep and complex shapes of the ventricles, preoperative planning is paramount. Two main surgical techniques are employed in endoscopic cylinder surgery. The wet-field technique involves the continuous irrigation of artificial cerebrospinal fluid (CSF) during the procedure, maintaining ventricle shape with natural water pressure, facilitating tumor border identification, and achieving spontaneous hemostasis. Conversely, the dry-field technique involves CSF drainage, providing a clear visual field even during hemorrhage encounters. In intraventricular surgery, both techniques are used and switched as needed.Specific approaches for lateral, third, and fourth ventricular tumors are discussed, considering their locations and surrounding anatomical structures. Detailed intraoperative findings and strategies for tumor removal and hemostasis are presented.Endoscopic cylinder surgery offers a versatile and minimally invasive option for intraventricular tumors, leading to improved surgical outcomes. Overall, this technique enhances surgical precision and patient outcomes in intraventricular tumor cases.
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Mahmoodi AL, Landers MJF, Rutten GJM, Brouwers HB. Characterization and Classification of Spatial White Matter Tract Alteration Patterns in Glioma Patients Using Magnetic Resonance Tractography: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:3631. [PMID: 37509291 PMCID: PMC10377290 DOI: 10.3390/cancers15143631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Magnetic resonance (MR) tractography can be used to study the spatial relations between gliomas and white matter (WM) tracts. Various spatial patterns of WM tract alterations have been described in the literature. We reviewed classification systems of these patterns, and investigated whether low-grade gliomas (LGGs) and high-grade gliomas (HGGs) demonstrate distinct spatial WM tract alteration patterns. METHODS We conducted a systematic review and meta-analysis to summarize the evidence regarding MR tractography studies that investigated spatial WM tract alteration patterns in glioma patients. RESULTS Eleven studies were included. Overall, four spatial WM tract alteration patterns were reported in the current literature: displacement, infiltration, disruption/destruction and edematous. There was a considerable heterogeneity in the operational definitions of these terms. In a subset of studies, sufficient homogeneity in the classification systems was found to analyze pooled results for the displacement and infiltration patterns. Our meta-analyses suggested that LGGs displaced WM tracts significantly more often than HGGs (n = 259 patients, RR: 1.79, 95% CI [1.14, 2.79], I2 = 51%). No significant differences between LGGs and HGGs were found for WM tract infiltration (n = 196 patients, RR: 1.19, 95% CI [0.95, 1.50], I2 = 4%). CONCLUSIONS The low number of included studies and their considerable methodological heterogeneity emphasize the need for a more uniform classification system to study spatial WM tract alteration patterns using MR tractography. This review provides a first step towards such a classification system, by showing that the current literature is inconclusive and that the ability of fractional anisotropy (FA) to define spatial WM tract alteration patterns should be critically evaluated. We found variations in spatial WM tract alteration patterns between LGGs and HGGs, when specifically examining displacement and infiltration in a subset of the included studies.
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Affiliation(s)
- Arash L Mahmoodi
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Maud J F Landers
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - H Bart Brouwers
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
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Li Y, Guo J, Zhang K, Wei H, Fan J, Yu S, Li T, Yang X. Diffusion tensor imaging versus intraoperative subcortical mapping for glioma resection: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:154. [PMID: 37380888 PMCID: PMC10307847 DOI: 10.1007/s10143-023-02058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
Maintaining the integrity of crucial fiber tracts allows functional preservation and improved recovery in patients with glioma resection. Diffusion tensor imaging (DTI) and intraoperative subcortical mapping (ISM) are commonly required for pre- and intraoperative assessment of white matter fibers. This study investigated differences of clinical outcomes in glioma resection aided by DTI or ISM. A comprehensive literature retrieval of the PubMed and Embase databases identified several DTI or ISM studies in 2000-2022. Clinical data, including extent of resection (EOR) and postoperative neurological deficits, was collected and statistically analyzed. Heterogeneity was regressed by a random effect model and the Mann-Whitney U test was used to test statistical significance. Publication bias was assessed by Egger test. A total of 14 studies with a pooled cohort of 1837 patients were included. Patients undergoing DTI-navigated glioma surgery showed a higher rate of gross total resection (GTR) than ISM-assisted surgical resection (67.88%, [95% CI 0.55-0.79] vs. 45.73%, [95% CI 0.29-0.63], P = 0.032). The occurrence of early postoperative functional deficit (35.45%, [95% CI 0.13-0.61] vs. 35.60% [95% CI 0.20-0.53], P = 1.000), late postoperative functional deficit (6.00%, [95% CI 0.02-0.11] vs. 4.91% [95% CI 0.03-0.08], P = 1.000) and severe postoperative functional deficit (2.21%, [95% CI 0-0.08] vs. 5.93% [95% CI 0.01-0.16], P = 0.393) were similar between the DTI and ISM group, respectively. While DTI-navigation resulted in a higher rate of GTR, the occurrence of postoperative neurological deficits between DTI and ISM groups was comparable. Together, these data indicate that both techniques could safely facilitate glioma resection.
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Affiliation(s)
- Yiming Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiahe Guo
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Zhang
- Institute for Intelligent Healthcare, Tsinghua University, Beijing, China
- Department of Neurosurgery, Tsinghua University Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Huijie Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jikang Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shengping Yu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
| | - Xuejun Yang
- Institute for Intelligent Healthcare, Tsinghua University, Beijing, China.
- Department of Neurosurgery, Tsinghua University Beijing Tsinghua Changgung Hospital, Beijing, China.
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Lalgudi Srinivasan H, Pedro Lavrador J, Tambirajoo K, Pang G, Patel S, Gullan R, Vergani F, Bhangoo R, Shapey J, Vasan AK, Ashkan K. Tractography-Enhanced Biopsy of Central Core Motor Eloquent Tumours: A Simulation-Based Study. J Pers Med 2023; 13:jpm13030467. [PMID: 36983649 PMCID: PMC10051818 DOI: 10.3390/jpm13030467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Safe Trajectory planning for navigation guided biopsy (nBx) of motor eloquent tumours (METs) is important to minimise neurological morbidity. Preliminary clinical data suggest that visualisation of the corticospinal tract (CST) and its relation to the tumour may aid in planning a safe trajectory. In this article we assess the impact of tractography in nBx planning in a simulation-based exercise. This single centre cross-sectional study was performed in March 2021 including 10 patients with METs divided into 2 groups: (1) tractography enhanced group (T-nBx; n = 5; CST merged with volumetric MRI); (2) anatomy-based group (A-nBx; n = 5; volumetric MRI only). A biopsy target was chosen on each tumour. Volunteer neurosurgical trainees had to plan a suitable biopsy trajectory on a Stealth S8® workstation for all patients in a single session. A trajectory safety index (TSI) was devised for each trajectory. Data collection and analysis included a comparison of trajectory planning time, trajectory/lobe changes and TSI. A total of 190 trajectories were analysed based on participation from 19 trainees. Mean trajectory planning time for the entire cohort was 225.1 ± 21.97 s. T-nBx required shorter time for planning (p = 0.01). Mean trajectory changes and lobe changes made per biopsy were 3.28 ± 0.29 and 0.45 ± 0.08, respectively. T-nBx required fewer trajectory/lobe changes (p = 0.01). TSI was better in the presence of tractography than A-nBx (p = 0.04). Neurosurgical experience of trainees had no significant impact on the measured parameters despite adjusted analysis. Irrespective of the level of neurosurgical training, surgical planning of navigation guided biopsy for METs may be achieved in less time with a safer trajectory if tractography imaging is available.
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Affiliation(s)
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
- King’s NeuroLab, King’s College Hospital, London WC2R 2LS, UK
| | | | - Graeme Pang
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
| | - Sabina Patel
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
| | - Richard Gullan
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
| | - Francesco Vergani
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
| | - Jonathan Shapey
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
- King’s NeuroLab, King’s College Hospital, London WC2R 2LS, UK
- Department of Surgical Intervention and Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
| | - Ahilan Kailaya Vasan
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
- King’s NeuroLab, King’s College Hospital, London WC2R 2LS, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital, London SE5 9RS, UK
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Listik C, Lapa JD, Casagrande SCB, Barbosa ER, Iglesio R, Godinho F, Duarte KP, Teixeira MJ, Cury RG. Exploring clinical outcomes in patients with idiopathic/inherited isolated generalized dystonia and stimulation of the subthalamic region. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:263-270. [PMID: 37059436 PMCID: PMC10104753 DOI: 10.1055/s-0043-1764416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Deep Brain Stimulation (DBS) is an established treatment option for refractory dystonia, but the improvement among the patients is variable. OBJECTIVE To describe the outcomes of DBS of the subthalamic region (STN) in dystonic patients and to determine whether the volume of tissue activated (VTA) inside the STN or the structural connectivity between the area stimulated and different regions of the brain are associated with dystonia improvement. METHODS The response to DBS was measured by the Burke-Fahn-Marsden Dystonia Rating Scale (BFM) before and 7 months after surgery in patients with generalized isolated dystonia of inherited/idiopathic etiology. The sum of the two overlapping STN volumes from both hemispheres was correlated with the change in BFM scores to assess whether the area stimulated inside the STN affects the clinical outcome. Structural connectivity estimates between the VTA (of each patient) and different brain regions were computed using a normative connectome taken from healthy subjects. RESULTS Five patients were included. The baseline BFM motor and disability subscores were 78.30 ± 13.55 (62.00-98.00) and 20.60 ± 7.80 (13.00-32.00), respectively. Patients improved dystonic symptoms, though differently. No relationships were found between the VTA inside the STN and the BFM improvement after surgery (p = 0.463). However, the connectivity between the VTA and the cerebellum structurally correlated with dystonia improvement (p = 0.003). CONCLUSIONS These data suggest that the volume of the stimulated STN does not explain the variance in outcomes in dystonia. Still, the connectivity pattern between the region stimulated and the cerebellum is linked to outcomes of patients.
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Affiliation(s)
- Clarice Listik
- Universidade de São Paulo, Center for Movement Disorders, Faculty of Medicine, Department of Neurology, São Paulo SP, Brazil
| | - Jorge Dornellys Lapa
- Universidade de São Paulo, Faculty of Medicine, Neurosurgery Division, Departament of de Neurology, São Paulo SP, Brazil
| | | | - Egberto Reis Barbosa
- Universidade de São Paulo, Center for Movement Disorders, Faculty of Medicine, Department of Neurology, São Paulo SP, Brazil
| | - Ricardo Iglesio
- Universidade de São Paulo, Faculty of Medicine, Neurosurgery Division, Departament of de Neurology, São Paulo SP, Brazil
| | - Fabio Godinho
- Universidade de São Paulo, Faculty of Medicine, Neurosurgery Division, Departament of de Neurology, São Paulo SP, Brazil
| | - Kleber Paiva Duarte
- Universidade de São Paulo, Faculty of Medicine, Neurosurgery Division, Departament of de Neurology, São Paulo SP, Brazil
| | - Manoel Jacobsen Teixeira
- Universidade de São Paulo, Faculty of Medicine, Neurosurgery Division, Departament of de Neurology, São Paulo SP, Brazil
| | - Rubens Gisbert Cury
- Universidade de São Paulo, Center for Movement Disorders, Faculty of Medicine, Department of Neurology, São Paulo SP, Brazil
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Martucci M, Russo R, Schimperna F, D’Apolito G, Panfili M, Grimaldi A, Perna A, Ferranti AM, Varcasia G, Giordano C, Gaudino S. Magnetic Resonance Imaging of Primary Adult Brain Tumors: State of the Art and Future Perspectives. Biomedicines 2023; 11:biomedicines11020364. [PMID: 36830900 PMCID: PMC9953338 DOI: 10.3390/biomedicines11020364] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
MRI is undoubtedly the cornerstone of brain tumor imaging, playing a key role in all phases of patient management, starting from diagnosis, through therapy planning, to treatment response and/or recurrence assessment. Currently, neuroimaging can describe morphologic and non-morphologic (functional, hemodynamic, metabolic, cellular, microstructural, and sometimes even genetic) characteristics of brain tumors, greatly contributing to diagnosis and follow-up. Knowing the technical aspects, strength and limits of each MR technique is crucial to correctly interpret MR brain studies and to address clinicians to the best treatment strategy. This article aimed to provide an overview of neuroimaging in the assessment of adult primary brain tumors. We started from the basilar role of conventional/morphological MR sequences, then analyzed, one by one, the non-morphological techniques, and finally highlighted future perspectives, such as radiomics and artificial intelligence.
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Affiliation(s)
- Matia Martucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Rosellina Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | | | - Gabriella D’Apolito
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Marco Panfili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Alessandro Grimaldi
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Perna
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Giuseppe Varcasia
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carolina Giordano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Simona Gaudino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Zhang M, Xiao X, Gu G, Zhang P, Wu W, Wang Y, Pan C, Wang L, Li H, Wu Z, Zhang J, Zhang L. Role of neuronavigation in the surgical management of brainstem gliomas. Front Oncol 2023; 13:1159230. [PMID: 37205194 PMCID: PMC10185888 DOI: 10.3389/fonc.2023.1159230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/20/2023] [Indexed: 05/21/2023] Open
Abstract
Objective NeuroNavigation (NN) is a widely used intraoperative imaging guidance technique in neurosurgical operations; however, its value in brainstem glioma (BSG) surgery is inadequately reported and lacks objective proof. This study aims to investigate the applicational value of NN in BSG surgery. Method A retrospective analysis was performed on 155 patients with brainstem gliomas who received craniotomy from May 2019 to January 2022 at Beijing Tiantan Hospital. Eighty-four (54.2%) patients received surgery with NN. Preoperative and postoperative cranial nerve dysfunctions, muscle strength, and Karnofsky (KPS) were evaluated. Patients' radiological features, tumor volume, and extent of resection (EOR) were obtained from conventional MRI data. Patients' follow-up data were also collected. Comparative analyses on these variables were made between the NN group and the non-NN group. Result The usage of NN is independently related to a higher EOR in diffuse intrinsic pontine glioma (DIPG) (p=0.005) and non-DIPG group (p<0.001). It was observed that fewer patients in the NN group suffered from deterioration of KPS (p=0.032) and cranial nerve function (p=0.017) in non-DIPG group, and deterioration of muscle strength (p=0.040) and cranial nerve function (p=0.038) in DIPG group. Moreover, the usage of NN is an independent protective factor for the deterioration of KPS (p=0.04) and cranial nerve function (p=0.026) in non-DIPG patients and the deterioration of muscle strength (p=0.009) in DIPG patients. Furthermore, higher EOR subgroups were found to be independently related to better prognoses in DIPG patients (p=0.008). Conclusion NN has significant value in BSG surgery. With the assistance of NN, BSG surgery achieved higher EOR without deteriorating patients' functions. In addition, DIPG patients may benefit from the appropriate increase of EOR.
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Affiliation(s)
- Mingxin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiong Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guocan Gu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhao Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Changcun Pan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Liwei Zhang,
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Yao S, Yang R, Du C, Jiang C, Wang Y, Peng C, Bai H. Maximal safe resection of diffuse lower grade gliomas primarily within central lobe using cortical/subcortical direct electrical stimulation under awake craniotomy. Front Oncol 2023; 13:1089139. [PMID: 36895476 PMCID: PMC9990258 DOI: 10.3389/fonc.2023.1089139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023] Open
Abstract
Background Diffuse lower-grade glioma (DLGG) in the central lobe is a challenge for safe resection procedures. To improve the extent of resection and reduce the risk of postoperative neurological deficits, we performed an awake craniotomy with cortical-subcortical direct electrical stimulation (DES) mapping for patients with DLGG located primarily within the central lobe. We investigated the outcomes of cortical-subcortical brain mapping using DES in an awake craniotomy for central lobe DLGG resection. Methods We performed a retrospective analysis of clinical data of a cohort of consecutively treated patients from February 2017 to August 2021 with diffuse lower-grade gliomas located primarily within the central lobe. All patients underwent awake craniotomy with DES for cortical and subcortical mapping of eloquent brain areas, neuronavigation, and/or ultrasound to identify tumor location. Tumors were removed according to functional boundaries. Maximum safe tumor resection was the surgical objective for all patients. Results Thirteen patients underwent 15 awake craniotomies with intraoperative mapping of eloquent cortices and subcortical fibers using DES. Maximum safe tumor resection was achieved according to functional boundaries in all patients. The pre-operative tumor volumes ranged from 4.3 cm3 to 137.3 cm3 (median 19.2 cm3). The mean extent of tumor resection was 94.6%, with eight cases (53.3%) achieving total resection, four (26.7%) subtotal and three (20.0%) partial. The mean tumor residue was 1.2 cm3. All patients experienced early postoperative neurological deficits or worsening conditions. Three patients (20.0%) experienced late postoperative neurological deficits at the 3-month follow-up, including one moderate and two mild neurological deficits. None of the patients experienced late onset severe neurological impairments post-operatively. Ten patients with 12 tumor resections (80.0%) had resumed activities of daily living at the 3-month follow-up. Among 14 patients with pre-operative epilepsy, 12 (85.7%) were seizure-free after treatment with antiepileptic drugs 7 days after surgery up to the last follow-up. Conclusions DLGG located primarily in the central lobe deemed inoperable can be safely resected using awake craniotomy with intraoperative DES without severe permanent neurological sequelae. Patients experienced an improved quality of life in terms of seizure control.
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Affiliation(s)
- Shujing Yao
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Ruixin Yang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Chenggang Du
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Che Jiang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yang Wang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Chongqi Peng
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Hongmin Bai
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
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Visualization of human optic nerve by diffusion tensor mapping and degree of neuropathy. PLoS One 2022; 17:e0278987. [PMID: 36508429 PMCID: PMC9744320 DOI: 10.1371/journal.pone.0278987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging of the human optic nerve and tract is technically difficult because of its small size, the inherent strong signal generated by the surrounding fat and the cerebrospinal fluid, and due to eddy current-induced distortions and subject movement artifacts. The effects of the bone canal through which the optic nerve passes, and the proximity of blood vessels, muscles and tendons are generally unknown. Also, the limited technical capabilities of the scanners and the minimization of acquisition times result in poor quality diffusion-weighted images. It is challenging for current tractography methods to accurately track optic pathway fibers that correspond to known anatomy. Despite these technical limitations and low image resolution, here we show how to visualize the optic nerve and tract and quantify nerve atrophy. Our visualization method based on the analysis of the diffusion tensor shows marked differences between a healthy male subject and a male subject with progressive optic nerve neuropathy. These differences coincide with diffusion scalar metrics and are not visible on standard morphological images. A quantification of the degree of optic nerve atrophy in a systematic way is provided and it is tested on 9 subjects from the Human Connectome Project.
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11
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Ortug A, Yuzbasioglu N, Akalan N, Levman J, Takahashi E. Preoperative and postoperative high angular resolution diffusion imaging tractography of cerebellar pathways in posterior fossa tumors. Clin Anat 2022; 35:1085-1099. [PMID: 35560729 PMCID: PMC9547814 DOI: 10.1002/ca.23914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/12/2022]
Abstract
This study aimed to utilize high angular resolution diffusion magnetic resonance imaging (HARDI) tractography in the mapping of the pathways of the cerebellum associated with posterior fossa tumors (infratentorial neoplasms) and to determine whether it is useful for preoperative and postoperative evaluation. Retrospective data from 30 patients (age 2-16 yr) with posterior fossa tumor (17 low grade, 13 high grade) and 30 age-sex-matched healthy controls were used. Structural and diffusion-weighted images were collected at a 3-tesla scanner. Tractography was performed using Diffusion Toolkit software, Q-ball model, FACT algorithm, and angle threshold of 45 degrees. Manually assessed regions of interest were placed to identify reconstructed fiber pathways passing through the superior, medial, and inferior cerebellar peduncles for the preoperative, postoperative, and healthy control groups. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and track volume measures were obtained and analyzed. Statistically significant differences were found between the preop/postop, preop/control, and postop/control comparisons for the volume of the tracts in both groups. Displacement and disruption of the pathways seemed to differ in relation to the severity of the tumor. The loss of pathways after the operation was associated with selective resection during surgery due to tumor infiltration. There were no FA differences but significantly higher ADC in low-grade tumors, and no difference in both FA and ADC in high-grade tumors. The effects of posterior fossa tumors on cerebellar peduncles and reconstructed pathways were successfully evaluated by HARDI tractography. The technique appears to be useful not only for preoperative but also for postoperative evaluation.
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Affiliation(s)
- A. Ortug
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, 34815, Turkey
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - N. Yuzbasioglu
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - N. Akalan
- Department of Neurosurgery, School of Medicine, Istanbul Medipol University, Istanbul, 34815, Turkey
| | - J. Levman
- Department of Computer Science, St. Francis Xavier University, Antigonish, Nova Scotia, B2G 2W5, Canada
| | - E. Takahashi
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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12
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Advanced Neuroimaging Approaches to Pediatric Brain Tumors. Cancers (Basel) 2022; 14:cancers14143401. [PMID: 35884462 PMCID: PMC9318188 DOI: 10.3390/cancers14143401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary After leukemias, brain tumors are the most common cancers in children, and early, accurate diagnosis is critical to improve patient outcomes. Beyond the conventional imaging methods of computed tomography (CT) and magnetic resonance imaging (MRI), advanced neuroimaging techniques capable of both structural and functional imaging are moving to the forefront to improve the early detection and differential diagnosis of tumors of the central nervous system. Here, we review recent developments in neuroimaging techniques for pediatric brain tumors. Abstract Central nervous system tumors are the most common pediatric solid tumors; they are also the most lethal. Unlike adults, childhood brain tumors are mostly primary in origin and differ in type, location and molecular signature. Tumor characteristics (incidence, location, and type) vary with age. Children present with a variety of symptoms, making early accurate diagnosis challenging. Neuroimaging is key in the initial diagnosis and monitoring of pediatric brain tumors. Conventional anatomic imaging approaches (computed tomography (CT) and magnetic resonance imaging (MRI)) are useful for tumor detection but have limited utility differentiating tumor types and grades. Advanced MRI techniques (diffusion-weighed imaging, diffusion tensor imaging, functional MRI, arterial spin labeling perfusion imaging, MR spectroscopy, and MR elastography) provide additional and improved structural and functional information. Combined with positron emission tomography (PET) and single-photon emission CT (SPECT), advanced techniques provide functional information on tumor metabolism and physiology through the use of radiotracer probes. Radiomics and radiogenomics offer promising insight into the prediction of tumor subtype, post-treatment response to treatment, and prognostication. In this paper, a brief review of pediatric brain cancers, by type, is provided with a comprehensive description of advanced imaging techniques including clinical applications that are currently utilized for the assessment and evaluation of pediatric brain tumors.
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13
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McAleavey PG, Walls GM, Chalmers AJ. Radiotherapy-drug combinations in the treatment of glioblastoma: a brief review. CNS Oncol 2022; 11:CNS86. [PMID: 35603818 PMCID: PMC9134931 DOI: 10.2217/cns-2021-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
Glioblastoma (GBM) accounts for over 50% of gliomas and carries the worst prognosis of all solid tumors. Owing to the limited local control afforded by surgery alone, efficacious adjuvant treatments such as radiotherapy (RT) and chemotherapy are fundamental in achieving durable disease control. The best clinical outcomes are achieved with tri-modality treatment consisting of surgery, RT and systemic therapy. While RT-chemotherapy combination regimens are well established in oncology, this approach was largely unsuccessful in GBM until the introduction of temozolomide. The success of this combination has stimulated the search for other candidate drugs for concomitant use with RT in GBM. This review seeks to collate the current evidence for these agents and synthesize possible future directions for the field.
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Affiliation(s)
- Patrick G McAleavey
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, N. Ireland
| | - Gerard M Walls
- Cancer Centre Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, N. Ireland
- Patrick G Johnston Centre for Cancer Research, Jubilee Road, Belfast, BT9 7AE, N. Ireland
| | - Anthony J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, G61 1QH, Scotland
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14
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Jha RR, Pathak SK, Nath V, Schneider W, Kumar BVR, Bhavsar A, Nigam A. VRfRNet: Volumetric ROI fODF reconstruction network for estimation of multi-tissue constrained spherical deconvolution with only single shell dMRI. Magn Reson Imaging 2022; 90:1-16. [PMID: 35341904 DOI: 10.1016/j.mri.2022.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 02/19/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
Diffusion MRI (dMRI) is one of the most popular techniques for studying the brain structure, mainly the white matter region. Among several sampling methods in dMRI, the high angular resolution diffusion imaging (HARDI) technique has attracted researchers due to its more accurate fiber orientation estimation. However, the current single-shell HARDI makes the intravoxel structure challenging to estimate accurately. While multi-shell acquisition can address this problem, it takes a longer scanning time, restricting its use in clinical applications. In addition, most existing dMRI scanners with low gradient-strengths often acquire single-shell up to b=1000s/mm2 because of signal-to-noise ratio issues and severe image artefacts. Hence, we propose a novel generative adversarial network, VRfRNet, for the reconstruction of multi-shell multi-tissue fiber orientation distribution function from single-shell HARDI volumes. Such a transformation learning is performed in the spherical harmonics (SH) space, as raw input HARDI volume is transformed to SH coefficients to soften gradient directions. The proposed VRfRNet consists of several modules, such as multi-context feature enrichment module, feature level attention, and softmax level attention. In addition, three loss functions have been used to optimize network learning, including L1, adversarial, and total variation. The network is trained and tested using standard qualitative and quantitative performance metrics on the publicly available HCP data-set.
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Affiliation(s)
- Ranjeet Ranjan Jha
- MANAS Lab, School of Computing and Electrical Engineering (SCEE), Indian Institute of Technology (IIT) Mandi, India.
| | - Sudhir K Pathak
- Learning Research and Development Center, University of Pittsburgh, USA
| | - Vishwesh Nath
- Vanderbilt Institute for Surgery and Engineering, Nashville, Tennessee, USA
| | - Walter Schneider
- Learning Research and Development Center, University of Pittsburgh, USA
| | - B V Rathish Kumar
- Department of Mathematics and Statistics, Indian Institute of Technology Kanpur, India
| | - Arnav Bhavsar
- MANAS Lab, School of Computing and Electrical Engineering (SCEE), Indian Institute of Technology (IIT) Mandi, India
| | - Aditya Nigam
- MANAS Lab, School of Computing and Electrical Engineering (SCEE), Indian Institute of Technology (IIT) Mandi, India
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15
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Zhylka A, Sollmann N, Kofler F, Radwan A, De Luca A, Gempt J, Wiestler B, Menze B, Krieg SM, Zimmer C, Kirschke JS, Sunaert S, Leemans A, Pluim JPW. Tracking the Corticospinal Tract in Patients With High-Grade Glioma: Clinical Evaluation of Multi-Level Fiber Tracking and Comparison to Conventional Deterministic Approaches. Front Oncol 2021; 11:761169. [PMID: 34970486 PMCID: PMC8712728 DOI: 10.3389/fonc.2021.761169] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/15/2021] [Indexed: 12/11/2022] Open
Abstract
While the diagnosis of high-grade glioma (HGG) is still associated with a considerably poor prognosis, neurosurgical tumor resection provides an opportunity for prolonged survival and improved quality of life for affected patients. However, successful tumor resection is dependent on a proper surgical planning to avoid surgery-induced functional deficits whilst achieving a maximum extent of resection (EOR). With diffusion magnetic resonance imaging (MRI) providing insight into individual white matter neuroanatomy, the challenge remains to disentangle that information as correctly and as completely as possible. In particular, due to the lack of sensitivity and accuracy, the clinical value of widely used diffusion tensor imaging (DTI)-based tractography is increasingly questioned. We evaluated whether the recently developed multi-level fiber tracking (MLFT) technique can improve tractography of the corticospinal tract (CST) in patients with motor-eloquent HGGs. Forty patients with therapy-naïve HGGs (mean age: 62.6 ± 13.4 years, 57.5% males) and preoperative diffusion MRI [repetition time (TR)/echo time (TE): 5000/78 ms, voxel size: 2x2x2 mm3, one volume at b=0 s/mm2, 32 volumes at b=1000 s/mm2] underwent reconstruction of the CST of the tumor-affected and unaffected hemispheres using MLFT in addition to deterministic DTI-based and deterministic constrained spherical deconvolution (CSD)-based fiber tractography. The brain stem was used as a seeding region, with a motor cortex mask serving as a target region for MLFT and a region of interest (ROI) for the other two algorithms. Application of the MLFT method substantially improved bundle reconstruction, leading to CST bundles with higher radial extent compared to the two other algorithms (delineation of CST fanning with a wider range; median radial extent for tumor-affected vs. unaffected hemisphere - DTI: 19.46° vs. 18.99°, p=0.8931; CSD: 30.54° vs. 27.63°, p=0.0546; MLFT: 81.17° vs. 74.59°, p=0.0134). In addition, reconstructions by MLFT and CSD-based tractography nearly completely included respective bundles derived from DTI-based tractography, which was however favorable for MLFT compared to CSD-based tractography (median coverage of the DTI-based CST for affected vs. unaffected hemispheres - CSD: 68.16% vs. 77.59%, p=0.0075; MLFT: 93.09% vs. 95.49%; p=0.0046). Thus, a more complete picture of the CST in patients with motor-eloquent HGGs might be achieved based on routinely acquired diffusion MRI data using MLFT.
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Affiliation(s)
- Andrey Zhylka
- Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Florian Kofler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
- TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Munich, Germany
| | - Ahmed Radwan
- Department of Imaging and Pathology, Translational MRI, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Department of Neurosciences, Leuven Brain Institute (LBI), Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Alberto De Luca
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
- Neurology Department, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Munich, Germany
| | - Bjoern Menze
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
- Department of Quantitative Biomedicine, University of Zurich (UZ), Zurich, Switzerland
| | - Sandro M. Krieg
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Sunaert
- Department of Imaging and Pathology, Translational MRI, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Department of Neurosciences, Leuven Brain Institute (LBI), Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Department of Radiology, Universitair Ziekenhuis (UZ) Leuven, Leuven, Belgium
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - Josien P. W. Pluim
- Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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16
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Abstract
As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative. From standard magnetic resonance imaging (MRI) sequences to functional neuroimaging, preoperative workups for metastatic disease allow high-resolution detection of lesions and at-risk structures, facilitating safe and effective surgical planning. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. Neuronavigation has become a cornerstone of operative workflow, while intraoperative ultrasound (iUS) and intraoperative brain mapping generate real-time renderings of the brain unaffected by brain shift. Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.
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Affiliation(s)
- Patrick R Ng
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bryan D Choi
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Manish K Aghi
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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He J, Zhang F, Xie G, Yao S, Feng Y, Bastos DCA, Rathi Y, Makris N, Kikinis R, Golby AJ, O'Donnell LJ. Comparison of multiple tractography methods for reconstruction of the retinogeniculate visual pathway using diffusion MRI. Hum Brain Mapp 2021; 42:3887-3904. [PMID: 33978265 PMCID: PMC8288095 DOI: 10.1002/hbm.25472] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/31/2022] Open
Abstract
The retinogeniculate visual pathway (RGVP) conveys visual information from the retina to the lateral geniculate nucleus. The RGVP has four subdivisions, including two decussating and two nondecussating pathways that cannot be identified on conventional structural magnetic resonance imaging (MRI). Diffusion MRI tractography has the potential to trace these subdivisions and is increasingly used to study the RGVP. However, it is not yet known which fiber tracking strategy is most suitable for RGVP reconstruction. In this study, four tractography methods are compared, including constrained spherical deconvolution (CSD) based probabilistic (iFOD1) and deterministic (SD-Stream) methods, and multi-fiber (UKF-2T) and single-fiber (UKF-1T) unscented Kalman filter (UKF) methods. Experiments use diffusion MRI data from 57 subjects in the Human Connectome Project. The RGVP is identified using regions of interest created by two clinical experts. Quantitative anatomical measurements and expert anatomical judgment are used to assess the advantages and limitations of the four tractography methods. Overall, we conclude that UKF-2T and iFOD1 produce the best RGVP reconstruction results. The iFOD1 method can better quantitatively estimate the percentage of decussating fibers, while the UKF-2T method produces reconstructed RGVPs that are judged to better correspond to the known anatomy and have the highest spatial overlap across subjects. Overall, we find that it is challenging for current tractography methods to both accurately track RGVP fibers that correspond to known anatomy and produce an approximately correct percentage of decussating fibers. We suggest that future algorithm development for RGVP tractography should take consideration of both of these two points.
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Affiliation(s)
- Jianzhong He
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of TechnologyHangzhouChina
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Fan Zhang
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Guoqiang Xie
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurosurgeryNuclear Industry 215 Hospital of Shaanxi ProvinceXianyangChina
| | - Shun Yao
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Center for Pituitary Tumor Surgery, Department of NeurosurgeryThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Yuanjing Feng
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of TechnologyHangzhouChina
| | - Dhiego C. A. Bastos
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Yogesh Rathi
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Psychiatry, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Nikos Makris
- Department of Psychiatry, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Departments of Psychiatry, Neurology and Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ron Kikinis
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra J. Golby
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Lauren J. O'Donnell
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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18
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Yang JYM, Yeh CH, Poupon C, Calamante F. Diffusion MRI tractography for neurosurgery: the basics, current state, technical reliability and challenges. Phys Med Biol 2021; 66. [PMID: 34157706 DOI: 10.1088/1361-6560/ac0d90] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/22/2021] [Indexed: 01/20/2023]
Abstract
Diffusion magnetic resonance imaging (dMRI) tractography is currently the only imaging technique that allows for non-invasive delineation and visualisation of white matter (WM) tractsin vivo,prompting rapid advances in related fields of brain MRI research in recent years. One of its major clinical applications is for pre-surgical planning and intraoperative image guidance in neurosurgery, where knowledge about the location of WM tracts nearby the surgical target can be helpful to guide surgical resection and optimise post-surgical outcomes. Surgical injuries to these WM tracts can lead to permanent neurological and functional deficits, making the accuracy of tractography reconstructions paramount. The quality of dMRI tractography is influenced by many modifiable factors, ranging from MRI data acquisition through to the post-processing of tractography output, with the potential of error propagation based on decisions made at each and subsequent processing steps. Research over the last 25 years has significantly improved the anatomical accuracy of tractography. An updated review about tractography methodology in the context of neurosurgery is now timely given the thriving research activities in dMRI, to ensure more appropriate applications in the clinical neurosurgical realm. This article aims to review the dMRI physics, and tractography methodologies, highlighting recent advances to provide the key concepts of tractography-informed neurosurgery, with a focus on the general considerations, the current state of practice, technical challenges, potential advances, and future demands to this field.
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Affiliation(s)
- Joseph Yuan-Mou Yang
- Department of Neurosurgery, The Royal Children's Hospital, Melbourne, Australia.,Neuroscience Research, Murdoch Children's Research Institute, Melbourne, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Chun-Hung Yeh
- Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Cyril Poupon
- NeuroSpin, Frédéric Joliot Life Sciences Institute, CEA, CNRS, Paris-Saclay University, Gif-sur-Yvette, France
| | - Fernando Calamante
- The University of Sydney, Sydney Imaging, Sydney, Australia.,The University of Sydney, School of Biomedical Engineering, Sydney, Australia
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19
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Duffau H. Neural Connectivity: How to Reinforce the Bidirectional Synapse Between Basic Neuroscience and Routine Neurosurgical Practice? Front Neurol 2021; 12:705135. [PMID: 34354668 PMCID: PMC8336871 DOI: 10.3389/fneur.2021.705135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," National Institute for Health and Medical Research (INSERM), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, Montpellier, France
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20
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Eskandari F, Shafieian M, Aghdam MM, Laksari K. The importance of axonal directions in the brainstem injury during neurosurgical interventions. Injury 2021; 52:1271-1276. [PMID: 33268074 DOI: 10.1016/j.injury.2020.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 02/02/2023]
Abstract
Brainstem, which connects the distal part of the brain and the spinal cord, contains main motor and sensory nerves and facilitates communication between the cerebrum, cerebellum, and spinal cord. Due to the complicated anatomy and neurostructure of brainstem, surgical interventions to resect brainstem tumors are particularly challenging, and new approaches to reduce the risk of surgical brain injury are of utmost importance. Although previous studies have investigated the structural anisotropy of brain white matter, the effect of axonal fibers on the mechanical properties of white matter has not yet been fully understood. The current study aims to compare the effect of axonal orientation on changes in material properties of brainstem under large deformations and failure through a novel approach. Using diffusion tensor imaging (DTI) on ex-vivo bovine brains, we determined the orientation of axons in brainstem. We extracted brainstem samples in two orthogonal directions, parallel and perpendicular to the axons, and subjected to uniaxial tension to reach the failure at loading rates of 50 mm/min and 150 mm/min. The results showed that the tearing energy and failure strain of samples with axons parallel to the force direction were approximately 1.5 times higher than the samples with axons perpendicular to the force direction. The results also revealed that as the sample's initial length increases, its failure strain decreases. These results emphasize the importance of the axon orientation in the mechanical properties of brainstem, and suggest that considering the directional-dependent behavior for this tissue could help to propose new surgical interventions for reducing the risk of injury during tumor resection.
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Affiliation(s)
- Faezeh Eskandari
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Mehdi Shafieian
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.
| | - Mohammad M Aghdam
- Department of Mechanical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Kaveh Laksari
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States
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21
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Rossi M, Sciortino T, Conti Nibali M, Gay L, Viganò L, Puglisi G, Leonetti A, Howells H, Fornia L, Cerri G, Riva M, Bello L. Clinical Pearls and Methods for Intraoperative Motor Mapping. Neurosurgery 2021; 88:457-467. [PMID: 33476393 PMCID: PMC7884143 DOI: 10.1093/neuros/nyaa359] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/26/2020] [Indexed: 12/13/2022] Open
Abstract
Resection of brain tumors involving motor areas and pathways requires the identification and preservation of various cortical and subcortical structures involved in motor control at the time of the procedure, in order to maintain the patient's full motor capacities. The use of brain mapping techniques has now been integrated into clinical practice for many years, as they help the surgeon to identify the neural structures involved in motor functions. A common definition of motor function, as well as knowledge of its neural organization, has been continuously evolving, underlining the need for implementing intraoperative strategies at the time of the procedure. Similarly, mapping strategies have been subjected to continuous changes, enhancing the likelihood of preservation of full motor capacities. As a general rule, the motor mapping strategy should be as flexible as possible and adapted strictly to the individual patient and clinical context of the tumor. In this work, we present an overview of current knowledge of motor organization, indications for motor mapping, available motor mapping, and monitoring strategies, as well as their advantages and limitations. The use of motor mapping improves resection and outcomes in patients harboring tumors involving motor areas and pathways, and should be considered the gold standard in the resection of this type of tumor.
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Affiliation(s)
- Marco Rossi
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Tommaso Sciortino
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Marco Conti Nibali
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Lorenzo Gay
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Luca Viganò
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Guglielmo Puglisi
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,Laboratory of Motor Control, Department of Biotechnology and Translational Medicine, Università degli Studi di Milano Milano, Italy
| | - Antonella Leonetti
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,Laboratory of Motor Control, Department of Biotechnology and Translational Medicine, Università degli Studi di Milano Milano, Italy
| | - Henrietta Howells
- Laboratory of Motor Control, Department of Biotechnology and Translational Medicine, Università degli Studi di Milano Milano, Italy
| | - Luca Fornia
- Laboratory of Motor Control, Department of Biotechnology and Translational Medicine, Università degli Studi di Milano Milano, Italy
| | - Gabriella Cerri
- Laboratory of Motor Control, Department of Biotechnology and Translational Medicine, Università degli Studi di Milano Milano, Italy
| | - Marco Riva
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Lorenzo Bello
- Neurosurgery , Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
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Afzali M, Pieciak T, Newman S, Garyfallidis E, Özarslan E, Cheng H, Jones DK. The sensitivity of diffusion MRI to microstructural properties and experimental factors. J Neurosci Methods 2021; 347:108951. [PMID: 33017644 PMCID: PMC7762827 DOI: 10.1016/j.jneumeth.2020.108951] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/27/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022]
Abstract
Diffusion MRI is a non-invasive technique to study brain microstructure. Differences in the microstructural properties of tissue, including size and anisotropy, can be represented in the signal if the appropriate method of acquisition is used. However, to depict the underlying properties, special care must be taken when designing the acquisition protocol as any changes in the procedure might impact on quantitative measurements. This work reviews state-of-the-art methods for studying brain microstructure using diffusion MRI and their sensitivity to microstructural differences and various experimental factors. Microstructural properties of the tissue at a micrometer scale can be linked to the diffusion signal at a millimeter-scale using modeling. In this paper, we first give an introduction to diffusion MRI and different encoding schemes. Then, signal representation-based methods and multi-compartment models are explained briefly. The sensitivity of the diffusion MRI signal to the microstructural components and the effects of curvedness of axonal trajectories on the diffusion signal are reviewed. Factors that impact on the quality (accuracy and precision) of derived metrics are then reviewed, including the impact of random noise, and variations in the acquisition parameters (i.e., number of sampled signals, b-value and number of acquisition shells). Finally, yet importantly, typical approaches to deal with experimental factors are depicted, including unbiased measures and harmonization. We conclude the review with some future directions and recommendations on this topic.
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Affiliation(s)
- Maryam Afzali
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom.
| | - Tomasz Pieciak
- AGH University of Science and Technology, Kraków, Poland; LPI, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Spain.
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA; Program of Neuroscience, Indiana University, Bloomington, IN 47405, USA.
| | - Eleftherios Garyfallidis
- Program of Neuroscience, Indiana University, Bloomington, IN 47405, USA; Department of Intelligent Systems Engineering, Indiana University, Bloomington, IN 47408, USA.
| | - Evren Özarslan
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
| | - Hu Cheng
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA; Program of Neuroscience, Indiana University, Bloomington, IN 47405, USA.
| | - Derek K Jones
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom.
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23
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Xiao X, Kong L, Pan C, Zhang P, Chen X, Sun T, Wang M, Qiao H, Wu Z, Zhang J, Zhang L. The role of diffusion tensor imaging and tractography in the surgical management of brainstem gliomas. Neurosurg Focus 2021; 50:E10. [PMID: 33386023 DOI: 10.3171/2020.10.focus20166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) have the ability to noninvasively visualize changes in white matter tracts, as well as their relationships with lesions and other structures. DTI/DTT has been increasingly used to improve the safety and results of surgical treatment for lesions in eloquent areas, such as brainstem cavernous malformations. This study aimed to investigate the application value of DTI/DTT in brainstem glioma surgery and to validate the spatial accuracy of reconstructed corticospinal tracts (CSTs). METHODS A retrospective analysis was performed on 54 patients with brainstem gliomas who had undergone surgery from January 2016 to December 2018 at Beijing Tiantan Hospital. All patients underwent preoperative DTI and tumor resection with the assistance of DTT-merged neuronavigation and electrophysiological monitoring. Preoperative conventional MRI and DTI data were collected, and the muscle strength and modified Rankin Scale (mRS) score before and after surgery were measured. The surgical plan was created with the assistance of DTI/DTT findings. The accuracy of DTI/DTT was validated by performing direct subcortical stimulation (DsCS) intraoperatively. Multiple linear regression was used to investigate the relationship between quantitative parameters of DTI/DTT (such as the CST score and tumor-to-CST distance [TCD]) and postoperative muscle strength and mRS scores. RESULTS Among the 54 patients, 6 had normal bilateral CSTs, 12 patients had unilateral CST impairments, and 36 had bilateral CSTs involved. The most common changes in the CSTs were deformation (n = 29), followed by deviation (n = 28) and interruption (n = 27). The surgical approach was changed in 18 cases (33.3%) after accounting for the DTI/DTT results. Among 55 CSTs on which DsCS was performed, 46 (83.6%) were validated as spatially accurate by DsCS. The CST score and TCD were significantly correlated with postoperative muscle strength (r = -0.395, p < 0.001, and r = 0.275, p = 0.004, respectively) and postoperative mRS score (r = 0.430, p = 0.001, and r = -0.329, p = 0.015, respectively). The CST score was independently linearly associated with postoperative muscle strength (t = -2.461, p = 0.016) and the postoperative mRS score (t = 2.052, p = 0.046). CONCLUSIONS DTI/DTT is a valuable tool in the surgical management of brainstem gliomas. With good accuracy, it can help optimize surgical planning, guide tumor resection, and predict the postoperative muscle strength and postoperative quality of life of patients.
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Affiliation(s)
| | - Lu Kong
- Departments of1Neurosurgery and
| | | | | | | | - Tao Sun
- Departments of1Neurosurgery and
| | - Mingran Wang
- 2Beijing Neurosurgical Institute, Capital Medical University; and.,3Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University
| | - Hui Qiao
- 2Beijing Neurosurgical Institute, Capital Medical University; and.,3Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University
| | - Zhen Wu
- Departments of1Neurosurgery and
| | | | - Liwei Zhang
- Departments of1Neurosurgery and.,4China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
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24
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Abstract
The clinical presentation of glioblastomas is varied, and definitive diagnosis requires pathologic examination and study of the tissue. Management of glioblastomas includes surgery and adjuvant chemotherapy and radiotherapy, with surgery playing an important role in the prognosis of these patients. Awake craniotomy plays a crucial role in tumors in or adjacent to eloquent areas, allowing surgeons to maximize resection, while minimizing iatrogenic deficits. However, the prognosis remains dismal. This article presents the perioperative management of patients with glioblastoma including tools and surgical adjuncts to maximize extent of resection and minimize poor outcomes.
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25
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Elliott CA, Danyluk H, Aronyk KE, Au K, Wheatley BM, Gross DW, Sankar T, Beaulieu C. Intraoperative acquisition of DTI in cranial neurosurgery: readout-segmented DTI versus standard single-shot DTI. J Neurosurg 2020; 133:1210-1219. [PMID: 31419798 DOI: 10.3171/2019.5.jns19890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) tractography is commonly used in neurosurgical practice but is largely limited to the preoperative setting. This is due primarily to image degradation caused by susceptibility artifact when conventional single-shot (SS) echo-planar imaging (EPI) DTI (SS-DTI) is acquired for open cranial, surgical position intraoperative DTI (iDTI). Readout-segmented (RS) EPI DTI (RS-DTI) has been reported to reduce such artifact but has not yet been evaluated in the intraoperative MRI (iMRI) environment. The authors evaluated the performance of RS versus SS EPI for DTI of the human brain in the iMRI setting. METHODS Pre- and intraoperative 3-T 3D T1-weighted and 2D multislice RS-iDTI (called RESOLVE [readout segmentation of long variable echo-trains] on the Siemens platform) and SS-iDTI images were acquired in 22 adult patients undergoing intraaxial iMRI resections for suspected low-grade glioma (14; 64%), high-grade glioma (7; 32%), or focal cortical dysplasia. Regional susceptibility artifact, anatomical deviation relative to T1-weighted imaging, and tractographic output for surgically relevant tracts were compared between iDTI sequences as well as the intraoperative tract shifts from preoperative DTI. RESULTS RS-iDTI resulted in qualitatively less regional susceptibility artifact (resection cavity, orbitofrontal and anterior temporal cortices) and mean anatomical deviation in regions most prone to susceptibility artifact (RS-iDTI 2.7 ± 0.2 vs SS-iDTI 7.5 ± 0.4 mm) compared to SS-iDTI. Although tract reconstruction success did not significantly differ by DTI method, susceptibility artifact-related tractography failure (of at least 1 surgically relevant tract) occurred for SS-iDTI in 8/22 (36%) patients, and in 5 of these 8 patients RS-iDTI permitted successful reconstruction. Among cases with successful tractography for both sequences, maximal intersequence differences were substantial (mean 9.5 ± 5.7 mm, range -27.1 to 18.7 mm). CONCLUSIONS RS EPI enables higher quality and more accurate DTI for surgically relevant tractography of major white matter tracts in intraoperative, open cranium neurosurgical applications at 3 T.
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Affiliation(s)
| | | | | | | | | | | | | | - Christian Beaulieu
- 4Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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26
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Liu X, Kinoshita M, Shinohara H, Hori O, Ozaki N, Hatta T, Honma S, Nakada M. Direct evidence of the relationship between brain metastatic adenocarcinoma and white matter fibers: A fiber dissection and diffusion tensor imaging tractography study. J Clin Neurosci 2020; 77:55-61. [PMID: 32409218 DOI: 10.1016/j.jocn.2020.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 01/28/2023]
Abstract
It is commonly known that brain metastases usually have clear boundaries in magnetic resonance imaging. However, little is known regarding the trajectory of white matter fibers around the tumors, especially using the fiber dissection technique. Here, we focused on the anatomical interaction between white matter fibers and the tumor, using the fiber dissection in a postmortem brain with metastatic tumor and compared the findings with those of diffusion tensor imaging (DTI) tractography. One postmortem human brain hemisphere with metastatic adenocarcinoma in the Broca's area was dissected using fiber dissection following the Klingler's method. In order to compare the in vitro and in vivo results, additional brains from 15 patients with metastatic adenocarcinomas, the volumes of which were comparable to that of the adenocarcinoma in the brain used for fiber dissection, were analyzed using DTI tractographic reconstruction. Morphological findings of white matter bundles running around the tumor were compared between the two techniques. In the fiber dissection technique, the superior longitudinal fascicle, arcuate fascicle, and frontal aslant tract could be dissected, and the white matter bundles were curved and retracted to avoid the tumor. In all the cases analyzed, white matter fibers or streamlines surrounding the tumor avoided the lesion. Using the fiber dissection technique, this is the first direct evidence to elucidate the anatomy of white matter fibers affected by a metastatic brain. This suggests that brain metastatic adenocarcinoma is an intra-axial neoplasm with extra-axial white matter structures.
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Affiliation(s)
- Xiaoliang Liu
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Harumichi Shinohara
- Department of Functional Anatomy, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Osamu Hori
- Department of Neuroanatomy, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Noriyuki Ozaki
- Department of Functional Anatomy, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Toshihisa Hatta
- Department of Anatomy I, Kanazawa Medical University, Kahoku, Ishikawa, Japan
| | - Satoru Honma
- Department of Anatomy II, Kanazawa Medical University, Kahoku, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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Li C, Wang S, Yan JL, Torheim T, Boonzaier NR, Sinha R, Matys T, Markowetz F, Price SJ. Characterizing tumor invasiveness of glioblastoma using multiparametric magnetic resonance imaging. J Neurosurg 2020; 132:1465-1472. [PMID: 31026822 DOI: 10.3171/2018.12.jns182926] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/26/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this study was to characterize the abnormalities revealed by diffusion tensor imaging (DTI) using MR spectroscopy (MRS) and perfusion imaging, and to evaluate the prognostic value of a proposed quantitative measure of tumor invasiveness by combining contrast-enhancing (CE) and DTI abnormalities in patients with glioblastoma. METHODS Eighty-four patients with glioblastoma were recruited preoperatively. DTI was decomposed into isotropic (p) and anisotropic (q) components. The relative cerebral blood volume (rCBV) was calculated from the dynamic susceptibility contrast imaging. Values of N-acetylaspartate, myoinositol, choline (Cho), lactate (Lac), and glutamate + glutamine (Glx) were measured from multivoxel MRS and normalized as ratios to creatine (Cr). Tumor regions of interest (ROIs) were manually segmented from the CE T1-weighted (CE-ROI) and DTI-q (q-ROI) maps. Perfusion and metabolic characteristics of these ROIs were measured and compared. The relative invasiveness coefficient (RIC) was calculated as a ratio of the characteristic radii of CE-ROI and q-ROI. The prognostic significance of RIC was tested using Kaplan-Meier and multivariate Cox regression analyses. RESULTS The Cho/Cr, Lac/Cr, and Glx/Cr in q-ROI were significantly higher than CE-ROI (p = 0.004, p = 0.005, and p = 0.007, respectively). CE-ROI had significantly higher rCBV values than q-ROI (p < 0.001). A higher RIC was associated with worse survival in a multivariate overall survival (OS) model (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.06-1.85, p = 0.016) and progression-free survival (PFS) model (HR 1.55, 95% CI 1.16-2.07, p = 0.003). An RIC cutoff value of 0.89 significantly predicted shorter OS (median 384 vs 605 days, p = 0.002) and PFS (median 244 vs 406 days, p = 0.001). CONCLUSIONS DTI-q abnormalities displayed higher tumor load and hypoxic signatures compared with CE abnormalities, whereas CE regions potentially represented the tumor proliferation edge. Integrating the extents of invasion visualized by DTI-q and CE images into clinical practice may lead to improved treatment efficacy.
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Affiliation(s)
- Chao Li
- 1Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences
- 2Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Jiun-Lin Yan
- 1Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences
- 4Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- 5Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Turid Torheim
- 6Cancer Research UK Cambridge Institute, and
- 7CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge
| | - Natalie R Boonzaier
- 1Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences
- 8Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London; and
| | - Rohitashwa Sinha
- 1Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences
| | - Tomasz Matys
- 3Department of Radiology
- 9Cancer Trials Unit, Department of Oncology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Florian Markowetz
- 6Cancer Research UK Cambridge Institute, and
- 7CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge
| | - Stephen J Price
- 1Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences
- 10Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
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Wende T, Hoffmann KT, Meixensberger J. Tractography in Neurosurgery: A Systematic Review of Current Applications. J Neurol Surg A Cent Eur Neurosurg 2020; 81:442-455. [PMID: 32176926 DOI: 10.1055/s-0039-1691823] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The ability to visualize the brain's fiber connections noninvasively in vivo is relatively young compared with other possibilities of functional magnetic resonance imaging. Although many studies showed tractography to be of promising value for neurosurgical care, the implications remain inconclusive. An overview of current applications is presented in this systematic review. A search was conducted for (("tractography" or "fiber tracking" or "fibre tracking") and "neurosurgery") that produced 751 results. We identified 260 relevant articles and added 20 more from other sources. Most publications concerned surgical planning for resection of tumors (n = 193) and vascular lesions (n = 15). Preoperative use of transcranial magnetic stimulation was discussed in 22 of these articles. Tractography in skull base surgery presents a special challenge (n = 29). Fewer publications evaluated traumatic brain injury (TBI) (n = 25) and spontaneous intracranial bleeding (n = 22). Twenty-three articles focused on tractography in pediatric neurosurgery. Most authors found tractography to be a valuable addition in neurosurgical care. The accuracy of the technique has increased over time. There are articles suggesting that tractography improves patient outcome after tumor resection. However, no reliable biomarkers have yet been described. The better rehabilitation potential after TBI and spontaneous intracranial bleeding compared with brain tumors offers an insight into the process of neurorehabilitation. Tractography and diffusion measurements in some studies showed a correlation with patient outcome that might help uncover the neuroanatomical principles of rehabilitation itself. Alternative corticofugal and cortico-cortical networks have been implicated in motor recovery after ischemic stroke, suggesting more complex mechanisms in neurorehabilitation that go beyond current models. Hence tractography may potentially be able to predict clinical deficits and rehabilitation potential, as well as finding possible explanations for neurologic disorders in retrospect. However, large variations of the results indicate a lack of data to establish robust diagnostical concepts at this point. Therefore, in vivo tractography should still be interpreted with caution and by experienced surgeons.
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Affiliation(s)
- Tim Wende
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
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Vanderweyen DC, Theaud G, Sidhu J, Rheault F, Sarubbo S, Descoteaux M, Fortin D. The role of diffusion tractography in refining glial tumor resection. Brain Struct Funct 2020; 225:1413-1436. [PMID: 32180019 DOI: 10.1007/s00429-020-02056-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022]
Abstract
Primary brain tumors are notoriously hard to resect surgically. Due to their infiltrative nature, finding the optimal resection boundary without damaging healthy tissue can be challenging. One potential tool to help make this decision is diffusion-weighted magnetic resonance imaging (dMRI) tractography. dMRI exploits the diffusion of water molecule along axons to generate a 3D modelization of the white matter bundles in the brain. This feature is particularly useful to visualize how a tumor affects its surrounding white matter and plan a surgical path. This paper reviews the different ways in which dMRI can be used to improve brain tumor resection, its benefits and also its limitations. We expose surgical tools that can be paired with dMRI to improve its impact on surgical outcome, such as loading the 3D tractography in the neuronavigation system and direct electrical stimulation to validate the position of the white matter bundles of interest. We also review articles validating dMRI findings using other anatomical investigation techniques, such as postmortem dissections, manganese-enhanced MRI, electrophysiological stimulations, and phantom studies with known ground truth. We will be discussing the areas of the brain where dMRI performs well and where the future challenges are. We will conclude this review with suggestions and take home messages for neurosurgeons, tractographers, and vendors for advancing the field and on how to benefit from tractography's use in clinical practice.
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Affiliation(s)
- Davy Charles Vanderweyen
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - Jasmeen Sidhu
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - François Rheault
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - Silvio Sarubbo
- Division of Neurosurgery, Emergency Area, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - David Fortin
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada
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Caras A, Mugge L, Miller WK, Mansour TR, Schroeder J, Medhkour A. Usefulness and Impact of Intraoperative Imaging for Glioma Resection on Patient Outcome and Extent of Resection: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 134:98-110. [DOI: 10.1016/j.wneu.2019.10.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
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31
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Liu X, Kinoshita M, Shinohara H, Hori O, Ozaki N, Nakada M. Does the superior fronto-occipital fascicle exist in the human brain? Fiber dissection and brain functional mapping in 90 patients with gliomas. NEUROIMAGE-CLINICAL 2020; 25:102192. [PMID: 32014826 PMCID: PMC6997620 DOI: 10.1016/j.nicl.2020.102192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/19/2019] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
Abstract
Existence of superior fronto-occipital fascicle (SFOF) in humans is controversial. Fiber dissection in vitro revealed Muratoff and Probst bundles but not SFOF. Direct functional mappings for SFOF were performed in 90 awake craniotomies. Eight of total 453 positive sites were located in the region believed to be SFOF. The anatomo-functional features suggest that SFOF might not exist in human brain.
The presence of the superior fronto-occipital fascicle (SFOF) has been reported in the Rhesus monkey; however, it is a subject of controversy in humans. The aim of this study is to identify the SFOF using both in vitro and in vivo anatomo-functional analyses. This study consisted of two approaches. First, one acallosal brain and 12 normal postmortem hemispheres (five left and seven right sides) were dissected under a microscope using Klingler's fiber dissection technique. We focused on the medial subcallosal area superior to the Muratoff bundle, which has been indicated as a principal target area of the SFOF in previous studies. Second, 90 patients underwent awake craniotomy for gliomas with direct electrical stimulations. Functional examinations for visual, ataxic, and cognitive tasks were performed and 453 positive mapping sites were investigated by voxel-based morphometry analysis to establish the functions of the SFOF. The corticostriatal fibers, or the Muratoff bundle, and thalamic peduncle fibers joined in the area of the caudate nucleus, making thalamic peduncle/ corticostriatal bundles, which ran antero-posteriorly in the anterior subcallosal area and radiated from the caudate superior margin in the posterior subcallosal area. However, no SFOF fiber bundle crossed perpendicular to the thalamic peduncle/ corticostriatal bundles in the posterior subcallosal area. In the acallosal hemispheres, Probst bundles were confirmed and the subcallosal areas did not show a specific organization different from the normal brain. Hence, we could not detect a long and continuous association fascicle connecting the frontal lobe and occipital or parietal lobe in the target areas. Furthermore, in the in vivo functional mappings of awake surgery and voxel-based morphometry analysis, eight positive points on the SFOF were selected from the total 453 positive points, but their functions were not related with visual processing and spatial awareness, as has been reported in previous studies. In conclusion, in the present study we attempted to investigate the existence of the SFOF using an anatomical and functional approach. According to our results, the SFOF may not exist in the human brain.
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Affiliation(s)
- Xiaoliang Liu
- Department of Neurosurgery, Kanazawa University,13-1 Takara-machi, Kanazawa, 920-8641 Japan; Department of Neurosurgery, The First Hospital of Jilin University, China
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University,13-1 Takara-machi, Kanazawa, 920-8641 Japan.
| | | | - Osamu Hori
- Department of Neuroanatomy, Kanazawa University, Japan
| | - Noriyuki Ozaki
- Department of Functional anatomy, Kanazawa University, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University,13-1 Takara-machi, Kanazawa, 920-8641 Japan
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Liu X, Tian W, Kolar B, Johnson MD, Milano MT, Jiang H, Lin S, Li D, Mohile NA, Li YM, Walter KA, Ekholm S, Wang HZ. The correlation of fractional anisotropy parameters with Ki-67 index, and the clinical implication in grading of non-enhancing gliomas and neuronal-glial tumors. Magn Reson Imaging 2019; 65:129-135. [PMID: 31644925 DOI: 10.1016/j.mri.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the correlation between the FA parameters and Ki-67 labeling index, and their diagnostic performance in grading supratentorial non-enhancing gliomas and neuronal-glial tumors (GNGT). METHODS This institutional review board-approved, Health Insurance Portability and Accountability (HIPAA) compliant retrospective study enrolled 35 patients, including 19 with low grade GNGT and 16 with high grade GNGT. The mean FA, maximal FA and mean maximal FA values derived from diffusion tensor imaging were measured. The correlation between the FA parameters and the Ki-67 labeling index was assessed by Spearman rank test. The receiver operating characteristic curve analysis and multivariate logistic regression analysis were performed to detect the optimal imaging parameters in grading GNGT. RESULTS The three FA parameters of low grade GNGT were significantly lower than the high grade GNGT (p < 0.001). The mean FA, maximal FA and mean maximal FA had significant positive correlation with Ki-67 labeling index (p = 0.001, p < 0.001, p < 0.001 respectively). The maximal FA showed a higher sensitivity and specificity in grading of non-enhancing GNGT with specificity of 78.9%, sensitivity of 100.0%, respectively. CONCLUSIONS The FA parameters correlated with Ki-67 labeling index, and were useful surrogates in preoperative grading supratentorial non-enhancing GNGT.
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Affiliation(s)
- Xiang Liu
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Wei Tian
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Balasubramanya Kolar
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Mahlon D Johnson
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Haihui Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China
| | - Dongmei Li
- Clinical and Translational Research and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Nimish A Mohile
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Yan M Li
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin A Walter
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sven Ekholm
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Li C, Wang S, Yan JL, Piper RJ, Liu H, Torheim T, Kim H, Zou J, Boonzaier NR, Sinha R, Matys T, Markowetz F, Price SJ. Intratumoral Heterogeneity of Glioblastoma Infiltration Revealed by Joint Histogram Analysis of Diffusion Tensor Imaging. Neurosurgery 2019; 85:524-534. [PMID: 30239840 DOI: 10.1093/neuros/nyy388] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 08/07/2018] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND Glioblastoma is a heterogeneous disease characterized by its infiltrative growth, rendering complete resection impossible. Diffusion tensor imaging (DTI) shows potential in detecting tumor infiltration by reflecting microstructure disruption. OBJECTIVE To explore the heterogeneity of glioblastoma infiltration using joint histogram analysis of DTI, to investigate the incremental prognostic value of infiltrative patterns over clinical factors, and to identify specific subregions for targeted therapy. METHODS A total of 115 primary glioblastoma patients were prospectively recruited for surgery and preoperative magnetic resonance imaging. The joint histograms of decomposed anisotropic and isotropic components of DTI were constructed in both contrast-enhancing and nonenhancing tumor regions. Patient survival was analyzed with joint histogram features and relevant clinical factors. The incremental prognostic values of histogram features were assessed using receiver operating characteristic curve analysis. The correlation between the proportion of diffusion patterns and tumor progression rate was tested using Pearson correlation. RESULTS We found that joint histogram features were associated with patient survival and improved survival model performance. Specifically, the proportion of nonenhancing tumor subregion with decreased isotropic diffusion and increased anisotropic diffusion was correlated with tumor progression rate (P = .010, r = 0.35), affected progression-free survival (hazard ratio = 1.08, P < .001), and overall survival (hazard ratio = 1.36, P < .001) in multivariate models. CONCLUSION Joint histogram features of DTI showed incremental prognostic values over clinical factors for glioblastoma patients. The nonenhancing tumor subregion with decreased isotropic diffusion and increased anisotropic diffusion may indicate a more infiltrative habitat and potential treatment target.
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Affiliation(s)
- Chao Li
- Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Neurosurgery, Shanghai General Hospital (originally named "Shanghai First People's Hospital"), Shanghai Jiao Tong University School of Medicine, China
| | - Shuo Wang
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Jiun-Lin Yan
- Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Rory J Piper
- Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Hongxiang Liu
- Molecular Malignancy Laboratory, Hematology and Oncology Diagnostic Service, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Turid Torheim
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
- CRUK and EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge, United Kingdom
| | - Hyunjin Kim
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Jingjing Zou
- Statistical laboratory, Centre for Mathematical Sciences, University of Cambridge, United Kingdom
| | - Natalie R Boonzaier
- Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
- Developmental Imaging and Biophysics Section, Institute of Child Health, University College London, London, United Kingdom
| | - Rohitashwa Sinha
- Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Tomasz Matys
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Cancer Trials Unit Department of Oncology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Florian Markowetz
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
- CRUK and EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge, United Kingdom
| | - Stephen J Price
- Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Schilling KG, Daducci A, Maier-Hein K, Poupon C, Houde JC, Nath V, Anderson AW, Landman BA, Descoteaux M. Challenges in diffusion MRI tractography - Lessons learned from international benchmark competitions. Magn Reson Imaging 2019; 57:194-209. [PMID: 30503948 PMCID: PMC6331218 DOI: 10.1016/j.mri.2018.11.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/17/2018] [Indexed: 12/13/2022]
Abstract
Diffusion MRI (dMRI) fiber tractography has become a pillar of the neuroimaging community due to its ability to noninvasively map the structural connectivity of the brain. Despite widespread use in clinical and research domains, these methods suffer from several potential drawbacks or limitations. Thus, validating the accuracy and reproducibility of techniques is critical for sound scientific conclusions and effective clinical outcomes. Towards this end, a number of international benchmark competitions, or "challenges", has been organized by the diffusion MRI community in order to investigate the reliability of the tractography process by providing a platform to compare algorithms and results in a fair manner, and evaluate common and emerging algorithms in an effort to advance the state of the field. In this paper, we summarize the lessons from a decade of challenges in tractography, and give perspective on the past, present, and future "challenges" that the field of diffusion tractography faces.
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Affiliation(s)
- Kurt G Schilling
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States of America.
| | | | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Cyril Poupon
- Neurospin, Frédéric Joliot Life Sciences Institute, CEA, Gif-sur-Yvette, France
| | - Jean-Christophe Houde
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, Québec, Canada
| | - Vishwesh Nath
- Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States of America
| | - Adam W Anderson
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States of America; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States of America
| | - Bennett A Landman
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States of America; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States of America; Department of Electrical Engineering, Vanderbilt University, Nashville, TN, United States of America
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, Québec, Canada
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Latini F, Fahlström M, Berntsson SG, Larsson EM, Smits A, Ryttlefors M. A novel radiological classification system for cerebral gliomas: The Brain-Grid. PLoS One 2019; 14:e0211243. [PMID: 30677090 PMCID: PMC6345500 DOI: 10.1371/journal.pone.0211243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/09/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Standard radiological/topographical classifications of gliomas often do not reflect the real extension of the tumor within the lobar-cortical anatomy. Furthermore, these systems do not provide information on the relationship between tumor growth and the subcortical white matter architecture. We propose the use of an anatomically standardized grid system (the Brain-Grid) to merge serial morphological magnetic resonance imaging (MRI) scans with a representative tractographic atlas. Two illustrative cases are presented to show the potential advantages of this classification system. Methods MRI scans of 39 patients (WHO grade II and III gliomas) were analyzed with a standardized grid created by intersecting longitudinal lines on the axial, sagittal, and coronal planes. The anatomical landmarks were chosen from an average brain, spatially normalized to the Montreal Neurological Institute (MNI) space and the Talairach space. Major white matter pathways were reconstructed with a deterministic tracking algorithm on a reference atlas and analyzed using the Brain-Grid system. Results In all, 48 brain grid voxels (areas defined by 3 coordinates, axial (A), coronal (C), sagittal (S) and numbers from 1 to 4) were delineated in each MRI sequence and on the tractographic atlas. The number of grid voxels infiltrated was consistent, also in the MNI space. The sub-cortical insula/basal ganglia (A3-C2-S2) and the fronto-insular region (A3-C2-S1) were most frequently involved. The inferior fronto-occipital fasciculus, anterior thalamic radiation, uncinate fasciculus, and external capsule were the most frequently associated pathways in both hemispheres. Conclusions The Brain-Grid based classification system provides an accurate observational tool in all patients with suspected gliomas, based on the comparison of grid voxels on a morphological MRI and segmented white matter atlas. Important biological information on tumor kinetics including extension, speed, and preferential direction of progression can be observed and even predicted with this system. This novel classification can easily be applied to both prospective and retrospective cohorts of patients and increase our comprehension of glioma behavior.
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Affiliation(s)
- Francesco Latini
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Shala G. Berntsson
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Anja Smits
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Ryttlefors
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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Sollmann N, Zhang H, Schramm S, Ille S, Negwer C, Kreiser K, Meyer B, Krieg SM. Function-specific Tractography of Language Pathways Based on nTMS Mapping in Patients with Supratentorial Lesions. Clin Neuroradiol 2018; 30:123-135. [PMID: 30519814 DOI: 10.1007/s00062-018-0749-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE In patients with supratentorial lesions diffusion tensor imaging fiber tracking (DTI-FT) is increasingly used to visualize subcortical fiber courses. Navigated transcranial magnetic stimulation (nTMS) was applied in this study to reveal specific cortical functions by investigating the particular language errors elicited by stimulation. To make DTI-FT more function-specific, the identified language-positive nTMS spots were used as regions of interest (ROIs). METHODS In this study 40 patients (mean age 53.8 ± 16.0 years) harboring language-eloquent left hemispheric lesions underwent preoperative nTMS language mapping. All induced error categories were separately defined as a ROI and used for function-specific nTMS-based DTI-FT. The fractions of patients showing various subcortical language-related pathways and the fibers-per-tract ratio (number of visualized fibers divided by the number of visualized tracts) were evaluated and compared for tractography with the single error types against less specific tractography including all identified cortical language sites (all errors except hesitations). RESULTS The nTMS-based DTI-FT using all errors except hesitations led to high fractions of visualized tracts (81.1% of patients), with a fibers-per-tract ratio of 538.4 ± 340.5. When only using performance errors, a predominant visualization of the superior longitudinal fascicle (SLF) occurred, which is known to be involved in articulatory processes. Fibers-per-tract ratios were comparatively stable for all single error categories when compared to all errors except hesitations (p > 0.05). CONCLUSION This is one of the first studies aiming on function-specific tractography. The results demonstrated that when using different error categories as ROIs, more detailed nTMS-based DTI-FT and, therefore, potentially superior intraoperative guidance becomes possible.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Haosu Zhang
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Severin Schramm
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Li Y, Zhang W. Quantitative evaluation of diffusion tensor imaging for clinical management of glioma. Neurosurg Rev 2018; 43:881-891. [PMID: 30417213 DOI: 10.1007/s10143-018-1050-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/26/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
Diffusion tensor imaging (DTI), assessing physiological motion of water in vivo, provides macroscopic view of microstructures of white matter in the central nervous system, and such imaging technique had been extensively used for the clinical treatment and research of glioma. This review mainly focuses on illuminating the merits of quantitative evaluation of DTI for glioma management. The content of the article includes DTI's application on tissue characterization, white matter tracts mapping, radiotherapy delineation, post-therapy outcome assessment, and multimodal imaging. At last, we elucidate a synoptic presentation of DTI limitation, which is critical for physicians making DTI-based clinical decisions in glioma management.
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Affiliation(s)
- Ye Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China.
| | - Wenyao Zhang
- Beijing Key Laboratory of Intelligent Information Technology, School of Computer Science, Beijing Institute of Technology, Beijing, 100081, China
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38
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Nilsson M, Englund E, Szczepankiewicz F, van Westen D, Sundgren PC. Imaging brain tumour microstructure. Neuroimage 2018; 182:232-250. [DOI: 10.1016/j.neuroimage.2018.04.075] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 01/18/2023] Open
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Abstract
STUDY DESIGN Case-control. OBJECTIVE The aim of this study was to understand the role of high-resolution magnetic resonance (MR) in identifying regional cord volume loss in cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Preliminary studies suggest that compression of the ventral region of the cord may contribute disproportionately to CSM symptomology; however, tract-specific data are lacking in the CSM population. The current study is the first to use 3T MR imaging (MRI) images of CSM patients to determine specific volume loss at the level of detail of individual descending white matter tracts. METHODS Twelve patients with CSM and 14 age-matched were enrolled prospectively and underwent 3-Tesla MRI of the cervical spine. Using the high-resolution images of the spinal cord, straightening and alignment with a template was performed and specific spinal cord tract volumes were measured using Spinal Cord Tool-box version 3.0.7. Modified Japanese orthopedic association (mJOA) and Nurick disability scores were collected in a prospective manner and were analyzed in relation to descending spinal tract volumes. RESULTS Having CSM was predicted by anterior/posterior diameter, eccentricity of the cord [odds ratio (OR) 0.000000621, P = 0.004], ventral reticulospinal tract volume (OR 1.167, P = 0.063), lateral corticospinal tract volume (OR 1.034, P = 0.046), rubrospinal tract volume (OR 1.072, P = 0.011), and ventrolateral reticulospinal tract volume (OR 1.474, P = 0.005) on single variable logistic regression. Single variable linear regression showed decreases in anterior/posterior spinal cord diameter (P = 0.022), ventral reticulospinal tract volumes (P = 0.007), and ventrolateral reticulospinal tract volumes (P = 0.017) to significantly predict worsening mJOA scores. Similarly, decreases in ventral reticulospinal tract volumes significantly predicted increasing Nurick scores (P = 0.039). CONCLUSION High-resolution 3T MRI can detect tract-specific volume loss in descending spinal cord tracts in CSM patients. Anterior/posterior spinal cord diameter, ventral reticulospinal tract, ventrolateral reticulospinal tract, lateral corticospinal tract, and rubrospinal tract volume loss are associated with CSM symptoms. LEVEL OF EVIDENCE 2.
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Conti Nibali M, Rossi M, Sciortino T, Riva M, Gay LG, Pessina F, Bello L. Preoperative surgical planning of glioma: limitations and reliability of fMRI and DTI tractography. J Neurosurg Sci 2018; 63:127-134. [PMID: 30290696 DOI: 10.23736/s0390-5616.18.04597-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Brain mapping techniques (intraoperative neurophysiology and neuropsychology) represent the gold standard in glioma surgery, and particularly in glioma resection. Since the introduction of MRI in the clinical practice, several advanced applications have been developed, like functional MRI (fMRI) and diffusion imaging-based tractography (DTI), which both have an application in glioma surgery. fMRI allows to identify cortical areas related to a specific function, DTI allows to reconstruct a model of the sub-cortical connectivity. This paper describes the clinical application of fMRI and DTI, enlightening sensitivity and specificity in comparison to gold standard and underlining their limitations in surgical decision making.
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Affiliation(s)
- Marco Conti Nibali
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy -
| | - Marco Rossi
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
| | - Tommaso Sciortino
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
| | - Marco Riva
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
| | - Lorenzo G Gay
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
| | - Federico Pessina
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Lorenzo Bello
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
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Lu CY, Chen XL, Chen XL, Fang XJ, Zhao YL. Clinical application of 3.0 T intraoperative magnetic resonance combined with multimodal neuronavigation in resection of cerebral eloquent area glioma. Medicine (Baltimore) 2018; 97:e11702. [PMID: 30142758 PMCID: PMC6112991 DOI: 10.1097/md.0000000000011702] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Glioma is the most common tumor among central nervous system tumors; surgical intervention presents difficulties. This is especially the case for gliomas in so-called "eloquent areas," as surgical resection threatens vital structures adjacent to the tumor. Intraoperative magnetic resonance imaging (iMRI) combined with multimodal neuronavigation may prove beneficial during surgery. This study explored the applicability of 3.0 T high field iMRI combined with multimodal neuronavigation in the resection of gliomas in eloquent brain areas.We reviewed 40 patients with a glioma located in the eloquent brains areas who underwent treatment in the Neurosurgery Department of Peking University International Hospital between December 2015 and August 2017. The experimental group included 20 patients treated using iMRI assistance technology (iMRI group). The remaining 20 patients underwent treatment by conventional neuronavigation (non-iMRI group). Tumor resection degree, preoperative and postoperative ability of daily living scale (Barthel index), infection rate, and operative time were compared between the 2 groups.No difference in infection rate was observed between the 2 groups. However, compared with the non-iMRI group, the iMRI group had a higher resection rate (96.55 ± 4.03% vs 87.70 ± 10.98%, P = .002), postoperative Barthel index (90.75 ± 12.90 vs 9.25 ± 16.41, P = .018), as well as a longer operation time (355.85 ± 61.40 vs 302.45 ± 64.09, P = .011).The use of iMRI technology can achieve a relatively higher resection rate among cases of gliomas in eloquent brain areas, with less incidence of postoperative neurological deficits. Although the operative time using iMRI was longer than that taken to perform conventional navigation surgery, the surgical infection rate in these 2 procedures showed no significant difference.
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Affiliation(s)
- Chang-Yu Lu
- Department of Neurosurgery, Peking University International Hospital
| | - Xiao-Lin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Xiao-Lei Chen
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Jing Fang
- Department of Neurosurgery, Peking University International Hospital
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
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Clinical Long-Term Follow-Up Evaluation of Functional Neuronavigation in Adult Cerebral Gliomas. World Neurosurg 2018; 119:e262-e271. [PMID: 30053568 DOI: 10.1016/j.wneu.2018.07.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the application of functional neuronavigation in surgeries of adult cerebral gliomas. METHODS We performed a retrospective analysis of 375 cases of adult cerebral glioma patients who underwent microsurgical treatment between 2011 and 2017 in our department. Among them, 142 patients underwent surgery using functional neuronavigation (group A), and the other 233 patients were operated on without the help of functional neuronavigation (group B). For both groups, we categorized them into several subgroups according to the lesion locations. RESULTS A significant difference in the gross total resection rate was observed between group A and group B (P = 0.001 for overall; P = 0.036 for EO area; and P = 0.004 for BBT area). The postoperative complication rate of group A was much lower than that of group B (P = 0.003 for overall; and P = 0.016 for BBT area). The postoperative 6-month Karnofsky Performance Scale score of all patients in group A was significantly higher than that of group B. Kaplan-Meier survival analyses showed significant increases in the median survival time of group A compared with that of group B (P < 0.001 for overall; P = 0.012 for EO area; P = 0.006 for BBT area), and the Cox proportional regression analysis estimated the hazard ratio of the functional neuronavigation to be 0.533, helping reduce the risk of death by 46.7%. CONCLUSIONS This study confirmed that the application of neuronavigation in adult glioma surgery can improve postoperative quality of life and lengthen the survival time of patients, especially in cases involving the brainstem and the eloquent area.
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Khalek Abdel Razek AA. Characterization of salivary gland tumours with diffusion tensor imaging. Dentomaxillofac Radiol 2018; 47:20170343. [PMID: 29412748 PMCID: PMC6196043 DOI: 10.1259/dmfr.20170343] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To characterize salivary glands tumours with diffusion tensor imaging. METHODS This study was conducted upon 53 patients (aged 18-81 years: mean 37 years) with salivary gland tumours that underwent diffusion tensor imaging was obtained using a single-shot echoplanar imaging sequence with parallel imaging at 1.5 T scanner. 48 slices were obtained, with a thickness of 2.5 mm, with no gap and the total scan duration was 7-8 min. The fractional anisotropy (FA) and the mean diffusivity (MD) value of the salivary gland tumours was calculated and correlated with pathological findings. Image analysis was performed by one radiologist. The receiver operating characteristic curve was drawn to detect the cut-off point of FA and MD used to characterize salivary gland tumours. RESULTS The mean FA and MD of malignant salivary gland tumours (n = 17) (0.41 ± 0.07 and 0.89 ± 0.15 × 10-3 mm2 s-1) was significantly different (p = 0.001) than that of benign tumours (n = 36) (0.19 ± 0.07 and 1.28 ± 0.42 × 10-3 mm2 s-1), respectively. Combined FA and MD used to differentiate malignant from benign tumours has an area under the curve (AUC) of 0.974, and an accuracy of 86%. There was a significant difference in FA between Warthin tumours and malignant tumours (p = 0.001). Selection FA of 0.35 to differentiate malignant tumours from Warthin tumours revealed AUC of 0.878 and an accuracy of 80%. There was a significant difference in FA and MD of malignant tumours and pleomorphic adenomas (p = 0.001). Combined FA and MD used to differentiate malignant tumours from pleomorphic adenomas revealed AUC of 0.993, and an accuracy of 93%. There was a significant difference in FA and MD of Warthin tumours and pleomorphic adenomas (p = 0.001). Combined FA and MD used to differentiate Warthin tumours from pleomorphic adenomas revealed AUC of 0.978, and an accuracy of 86%. CONCLUSIONS Diffusion-weighed imaging is a promising non-invasive method and it may be useful for the characterization and differentiation of benign and malignant salivary gland tumours.
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Hou Z, Cai X, Li H, Zeng C, Wang J, Gao Z, Zhang M, Dou W, Zhang N, Zhang L, Xie J. Quantitative Assessment of Invasion of High-Grade Gliomas Using Diffusion Tensor Magnetic Resonance Imaging. World Neurosurg 2018; 113:e561-e567. [PMID: 29482009 DOI: 10.1016/j.wneu.2018.02.095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine heterogeneity of high-grade glioma (HGG) and its surrounding area and explore quantitative analysis of invasion of HGG using diffusion tensor imaging. METHODS This study included 14 patients with HGG and preoperative magnetic resonance imaging and diffusion tensor imaging examinations. Three regions of interest were placed. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of these regions of interest were measured, and specimens from the 3 regions of interest were obtained under navigation guidance. Postoperative examinations of specimens were carried out. Correlations between ADC and FA values and tumor cell density were evaluated. RESULTS Median survival was 36.7 months. As distance from the tumor increased, the number of tumor cells significantly decreased. Regarding levels of matrix metalloproteinase-9 and Ki-67, only the differences between tumor and distances of 1 cm and 2 cm away from the tumor were statistically significant. For analysis of the relationship between tumor cell density and ADC and FA values, the discriminant formulas were as follows: G1 = -13.678 + 14984.791 (X) + 14443.847 (Y) (tumor cell density ≥10%); G2 = -11.649 + 14443.847 (X) + 33.285 (Y) (tumor cell density <10%). CONCLUSIONS We verified the heterogeneity of HGG and its surrounding area and found that patients with extensive resection may have longer survival. We also found a few formulas using FA and ADC values to predict tumor cell density.
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Affiliation(s)
- Zonggang Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xu Cai
- Department of Neurosurgery, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Huan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chun Zeng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiangfei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhixian Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mingyu Zhang
- Department of Radiology, Beijing Neurosurgical Institute, Beijing, China
| | - Weibei Dou
- Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Ning Zhang
- Health Management and Education Institute, Capital Medical University, Beijing, China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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45
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Leote J, Nunes RG, Cerqueira L, Loução R, Ferreira HA. Reconstruction of white matter fibre tracts using diffusion kurtosis tensor imaging at 1.5T: Pre-surgical planning in patients with gliomas. Eur J Radiol Open 2018; 5:20-23. [PMID: 29719853 PMCID: PMC5926250 DOI: 10.1016/j.ejro.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/18/2018] [Indexed: 12/04/2022] Open
Abstract
Tractography studies for pre-surgical planning of primary brain tumors is typically done using diffusion tensor imaging (DTI), which cannot resolve crossing, kissing or highly angulated fibres. Tractography based on the estimation of the diffusion kurtosis (DK) tensor was recently demonstrated to enable tackling these limitations. However, its use in the clinical context at low 1.5T field has not yet been reported. PURPOSE To evaluate if the estimation of whole-brain tractography using the DK tensor is feasible for pre-surgical investigation of patients with brain tumors at 1.5T. METHODS Eight healthy subjects and 3 patients with brain tumors were scanned at 1.5T using a 12-channel head coil. Diffusion-weighted images were acquired with repetition/echo times of 5800/107 ms, 82 × 82 resolution, 3 × 3 × 3 mm3 voxel size, b-values of 0, 1000, 2000 s/mm2 and 64 gradient sensitising directions. Whole-brain tractography was estimated using the DK tensor and corticospinal tracts (CST) were isolated using regions-of-interest placed at the cerebral peduncles and motor gyrus. Tract size, DK metrics and CST deviation index (highest curvature point) were compared between healthy subjects and patients. RESULTS Tract sizes did not differ between groups. The CST deviation index was significantly higher in patients compared to healthy subjects. Fractional anisotropy was significantly lower in patients, with higher mean kurtosis asymmetry index at the highest curvature point in patients. CONCLUSIONS Corticospinal fibre bundles estimated using DK tensor in a 1.5T scanner presented similar properties in patients with brain gliomas as those reported in the literature using DTI-based tractography.
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Affiliation(s)
- Joao Leote
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal
- Neurosurgery Department, Hospital Garcia de Orta, Almada, Portugal
| | - Rita G. Nunes
- Institute for Systems and Robotics (LARSyS) and Department of Bioengineering, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - Luis Cerqueira
- Neuroradiology Department, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Ricardo Loução
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal
| | - Hugo A. Ferreira
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal
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46
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Salama GR, Heier LA, Patel P, Ramakrishna R, Magge R, Tsiouris AJ. Diffusion Weighted/Tensor Imaging, Functional MRI and Perfusion Weighted Imaging in Glioblastoma-Foundations and Future. Front Neurol 2018; 8:660. [PMID: 29403420 PMCID: PMC5786563 DOI: 10.3389/fneur.2017.00660] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/22/2017] [Indexed: 01/20/2023] Open
Abstract
In this article, we review the basics of diffusion tensor imaging and functional MRI, their current utility in preoperative neurosurgical mapping, and their limitations. We also discuss potential future applications, including implementation of resting state functional MRI. We then discuss perfusion and diffusion-weighted imaging and their application in advanced neuro-oncologic practice. We explain how these modalities can be helpful in guiding surgical biopsies and differentiating recurrent tumor from treatment related changes.
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Affiliation(s)
- Gayle R Salama
- Department of Neuroradiology, Weill Cornell Medical College, New York, NY, United States
| | - Linda A Heier
- Department of Neuroradiology, Weill Cornell Medical College, New York, NY, United States
| | - Praneil Patel
- Department of Neuroradiology, Weill Cornell Medical College, New York, NY, United States
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Rajiv Magge
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
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47
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Glenn C, Conner AK, Rahimi M, Briggs RG, Baker C, Sughrue M. Common Disconnections in Glioma Surgery: An Anatomic Description. Cureus 2017; 9:e1778. [PMID: 29255657 PMCID: PMC5732013 DOI: 10.7759/cureus.1778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Within the surgical treatment of glioma, extended survival is predicated upon extent of resection which is limited by proximity and/or invasion of eloquent structures. Diffusion tensor imaging (DTI) tractography is a very useful tool for guiding supramaximal surgical resection while preserving eloquence. Although gliomas can vary significantly in size, shape, and invasion of functionally significant brain tissue, typical surgical disconnection patterns emerge. In this study, our typical surgical paradigm is outlined. We describe our surgical philosophy for resecting gliomas supramaximally summarized as define, divide, and destroy with the adjuvant utilization of neuronavigation and DTI. We describe the most common disconnections involved in glioma surgery at our institution; specifically, delineating tumor disconnections involving the medial posterior frontal, lateral posterior frontal, posterior temporal, anterior occipital, medial parietal, and insular regions. Although gliomas are highly variable, common patterns emerge in relation to the necessary disconnections required to preserve eloquent brain while maximizing the extent of resection.
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Affiliation(s)
- Chad Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Meherzad Rahimi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Cordell Baker
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Michael Sughrue
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
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48
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Behan B, Chen DQ, Sammartino F, DeSouza DD, Wharton-Shukster E, Hodaie M. Comparison of Diffusion-Weighted MRI Reconstruction Methods for Visualization of Cranial Nerves in Posterior Fossa Surgery. Front Neurosci 2017; 11:554. [PMID: 29062268 PMCID: PMC5640769 DOI: 10.3389/fnins.2017.00554] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 09/21/2017] [Indexed: 12/15/2022] Open
Abstract
Diffusion-weighted imaging (DWI)-based tractography has gained increasing popularity as a method for detailed visualization of white matter (WM) tracts. Different imaging techniques, and more novel, advanced imaging methods provide significant WM structural detail. While there has been greater focus on improving tract visualization for larger WM pathways, the relative value of each method for cranial nerve reconstruction and how this methodology can assist surgical decision-making is still understudied. Images from 10 patients with posterior fossa tumors (4 male, mean age: 63.5), affecting either the trigeminal nerve (CN V) or the facial/vestibular complex (CN VII/VIII), were employed. Three distinct reconstruction methods [two tensor-based methods: single diffusion tensor tractography (SDT) (3D Slicer), eXtended streamline tractography (XST), and one fiber orientation distribution (FOD)-based method: streamline tractography using constrained spherical deconvolution (CSD)-derived estimates (MRtrix3)], were compared to determine which of these was best suited for use in a neurosurgical setting in terms of processing speed, anatomical accuracy, and accurate depiction of the relationship between the tumor and affected CN. Computation of the tensor map was faster when compared to the implementation of CSD to provide estimates of FOD. Both XST and CSD-based reconstruction methods tended to give more detailed representations of the projections of CN V and CN VII/VIII compared to SDT. These reconstruction methods were able to more accurately delineate the course of CN V and CN VII/VIII, differentiate CN V from the cerebellar peduncle, and delineate compression of CN VII/VIII in situations where SDT could not. However, CSD-based reconstruction methods tended to generate more invalid streamlines. XST offers the best combination of anatomical accuracy and speed of reconstruction of cranial nerves within this patient population. Given the possible anatomical limitations of single tensor models, supplementation with more advanced tensor-based reconstruction methods might be beneficial.
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Affiliation(s)
- Brendan Behan
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Institute, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - David Q Chen
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Institute, University Health Network, Toronto, ON, Canada.,Department of Surgery, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Francesco Sammartino
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Danielle D DeSouza
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Institute, University Health Network, Toronto, ON, Canada.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Erika Wharton-Shukster
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Institute, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Mojgan Hodaie
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Institute, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada.,Department of Surgery, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
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49
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Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
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Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
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50
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Bette S, Huber T, Gempt J, Boeckh-Behrens T, Wiestler B, Kehl V, Ringel F, Meyer B, Zimmer C, Kirschke JS. Local Fractional Anisotropy Is Reduced in Areas with Tumor Recurrence in Glioblastoma. Radiology 2017; 283:499-507. [DOI: 10.1148/radiol.2016152832] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stefanie Bette
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Thomas Huber
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Jens Gempt
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Tobias Boeckh-Behrens
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Benedikt Wiestler
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Victoria Kehl
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Florian Ringel
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Bernhard Meyer
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Claus Zimmer
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Jan S. Kirschke
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
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