Microstructural changes of white matter fiber tracts induced by insular glioma revealed by tract-based spatial statistics and automatic fiber quantification

Microstructural Abnormalities in the Contralateral Normal-appearing White Matter of Glioblastoma Patients Evaluated with Advanced Diffusion Imaging

PURPOSE

Glioblastoma patients develop recurrence in the opposite hemisphere far from the primary tumor site even after complete resection. This is one of the main reasons for short disease survival. Our aim in this study is to detect microstructural changes in the contralateral hemisphere of glioblastoma patients using different diffusion models with the fully automated tract-based spatial statistics (TBSS) method.

METHODS

Fourteen right-sided and eleven left-sided glioblastoma patients without any treatment and eighteen age- and gender-matched controls were included in the study. Multi-shell diffusion weighted images were created with a 3T MRI device. After various preprocessing steps, images of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), axial kurtosis (AK), mean kurtosis (MK), radial kurtosis (RK), intracellular volume fraction (ICVF), orientation dispersion index (ODI), and isotropic water fraction (ISO) were obtained. TBSS was used to compare diffusion tensor imaging, diffusion kurtosis imaging, and neurite orientation dispersion and density imaging parameters of right- and left-sided glioblastoma patients with the control group for the contralateral hemisphere.

RESULTS

Both right-sided and left-sided glioblastoma patients have shown an increase in MD and ODI in the contralateral hemisphere. While right-sided glioblastoma patients showed an increase in RD, AD, and ISO in a more limited area in the contralateral hemisphere, left-sided glioblastoma patients showed an increase in MK and AK. FA, ICVF, and RK did not show any difference in both groups.

CONCLUSION

There are microstructural changes in the contralateral hemisphere in glioblastoma patients, and these changes differ between right-sided and left-sided glioblastoma patients.

Diffusion tensor imaging in detecting gliomas sub-regions of infiltration, local and remote recurrences: a systematic review

Given that glioma cells tend to infiltrate and migrate along WM tracts, leading to demyelination and axonal injuries, Diffusion Tensor Imaging (DTI) emerged as a promising tool for identifying major "high-risk areas" of recurrence within the peritumoral brain zone (PBZ) or at a distance throughout the adjacents white matter tracts. Of our systematic review is to answer the following research question: In patients with brain tumor, is DTI able to recognizes within the peri-tumoral brain zone (PBZ) areas more prone to local (near the surgical cavity) or remote recurrence compared to the conventional imaging techniques?. We conducted a comprehensive literature search to identify relevant studies in line with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. 15 papers were deemed compatible with our research question and included. To enhance the paper's readability, we have categorized our findings into two distinct groups: the first delves into the role of DTI in detecting PBZ sub-regions of infiltration and local recurrences (n = 8), while the second group explores the feasibility of DTI in detecting white matter tract infiltration and remote recurrences (n = 7). DTI values and, within a broader framework, radiomics investigations can provide precise, voxel-by-voxel insights into the state of PBZ and recurrences. Better defining the regions at risk for potential recurrence within the PBZ and along WM bundles will allow targeted therapy.

Cortical myelin and thickness mapping provide insights into whole-brain tumor burden in diffuse midline glioma

Systemic infiltration is a hallmark of diffuse midline glioma pathogenesis, which can trigger distant disturbances in cortical structure. However, the existence and effects of these changes have been underexamined. This study aimed to investigate whole-brain cortical myelin and thickness alternations induced by diffuse midline glioma. High-resolution T1- and T2-weighted images were acquired from 90 patients with diffuse midline glioma with H3 K27-altered and 64 patients with wild-type and 86 healthy controls. Cortical thickness and myelin content was calculated using Human Connectome Project pipeline. Significant differences in cortical thickness and myelin content were detected among groups. Short-term survival prediction model was constructed using automated machine learning. Compared with healthy controls, diffuse midline glioma with H3 K27-altered patients showed significantly reduced cortical myelin in bilateral precentral gyrus, postcentral gyrus, insular, parahippocampal gyrus, fusiform gyrus, and cingulate gyrus, whereas diffuse midline glioma with H3 K27 wild-type patients exhibited well-preserved myelin content. Furtherly, when comparing diffuse midline glioma with H3 K27-altered and diffuse midline glioma with H3 K27 wild-type, the decreased cortical thickness in parietal and occipital regions along with demyelination in medial orbitofrontal cortex was observed in diffuse midline glioma with H3 K27-altered. Notably, a combination of cortical features and tumor radiomics allowed short-term survival prediction with accuracy 0.80 and AUC 0.84. These findings may aid clinicians in tailoring therapeutic approaches based on cortical characteristics, potentially enhancing the efficacy of current and future treatment modalities.

Paediatric supratentorial tumours do not cause microstructural alterations in contralateral white matter: a preliminary study

BACKGROUND AND PURPOSE

Intracranial tumours in children can exhibit different characteristics compared to those in adults. Understanding the microstructural changes in the contralateral normal-appearing white matter (NAWM) in children with primary intracranial masses is essential for optimizing treatment strategies. This study aimed to investigate the apparent diffusion coefficient (ADC) changes in contralateral NAWM using fully automated methods and deep learning algorithms.

METHODS

We included 22 paediatric patients with primary supratentorial intracranial masses (23% high-grade) in the study. ADC values of the contralateral NAWM in the patient group were compared to those of a control group. Deep learning algorithms were utilized to analyse diffusion changes in NAWM.

RESULTS

The mean ADC values of contralateral NAWM in the patient group were 0.80 ± 0.03 × 10-3 mm2/s, while the control group had a mean ADC value of 0.81 ± 0.03 × 10-3 mm2/s. There was no statistically significant difference between the groups (p = 0.39). Our findings indicate that there are no significant diffusion changes in the contralateral white matter of children with supratentorial intracranial masses.

CONCLUSION

Primary supratentorial intracranial masses in children do not cause microstructural changes in contralateral normal-appearing white matter. This could be attributed to the less infiltrative nature and different biochemical profile of these tumour groups in the paediatric population. Further studies using advanced imaging techniques could provide additional insights into the distinct characteristics of paediatric intracranial tumours and improve patient management.