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Tracking the Corticospinal Tract in Patients With High-Grade Glioma: Clinical Evaluation of Multi-Level Fiber Tracking and Comparison to Conventional Deterministic Approaches
被引:9
作者:
Zhylka, Andrey
[1
]
Sollmann, Nico
[2
,3
,4
,5
]
Kofler, Florian
[3
,6
,7
]
Radwan, Ahmed
[8
,9
]
De Luca, Alberto
[10
,11
]
Gempt, Jens
[12
]
Wiestler, Benedikt
[3
,7
]
Menze, Bjoern
[6
,13
]
Krieg, Sandro M.
[4
,12
]
Zimmer, Claus
[3
,4
]
Kirschke, Jan S.
[3
,4
]
Sunaert, Stefan
[8
,9
,14
]
Leemans, Alexander
[10
]
Pluim, Josien P. W.
[1
]
机构:
[1] Eindhoven Univ Technol, Biomed Engn, Eindhoven, Netherlands
[2] Univ Hosp Ulm, Dept Diagnost & Intervent Radiol, Ulm, Germany
[3] Tech Univ Munich, Sch Med, Dept Diagnost & Intervent Neuroradiol, Klinikum Rechts Isar, Munich, Germany
[4] Tech Univ Munich, Klinikum Rechts Isar, TUM Neuroimaging Ctr, Munich, Germany
[5] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, San Francisco, CA 94143 USA
[6] Tech Univ Munich, Dept Informat, Image Based Biomed Modeling, Munich, Germany
[7] Tech Univ Munich, TranslaTUM Cent Inst Translat Canc Res, Munich, Germany
[8] Katholieke Univ KU Leuven, Dept Imaging & Pathol, Translat MRI, Leuven, Belgium
[9] Katholieke Univ KU Leuven, Leuven Brain Inst LBI, Dept Neurosci, Leuven, Belgium
[10] Univ Med Ctr Utrecht, Image Sci Inst, Utrecht, Netherlands
[11] Univ Med Ctr Utrecht, UMC Utrecht Brain Ctr, Neurol Dept, Utrecht, Netherlands
[12] Tech Univ Munich, Klinikum Rechts Isar, Sch Med, Dept Neurosurg, Munich, Germany
[13] Univ Zurich UZ, Dept Quantitat Biomed, Zurich, Switzerland
[14] Univ Ziekenhuis UZ Leuven, Dept Radiol, Leuven, Belgium
基金:
欧盟地平线“2020”;
关键词:
fiber tractography;
diffusion MRI;
brain tumor;
corticospinal tract (CST);
neurosurgery planning;
CONSTRAINED SPHERICAL DECONVOLUTION;
QUALITY-OF-LIFE;
DIFFUSION MRI;
WHITE-MATTER;
FUNCTIONAL MRI;
BRAIN-TUMORS;
TRACTOGRAPHY;
RESECTION;
EXTENT;
DTI;
D O I:
10.3389/fonc.2021.761169
中图分类号:
R73 [肿瘤学];
学科分类号:
100214 ;
摘要:
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-naive 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 mm(3), one volume at b=0 s/mm(2), 32 volumes at b=1000 s/mm(2)] 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 degrees vs. 18.99 degrees, p=0.8931; CSD: 30.54 degrees vs. 27.63 degrees, p=0.0546; MLFT: 81.17 degrees vs. 74.59 degrees, 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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页数:15
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