Preoperative and Intraoperative Diffusion Tensor Imaging-based Fiber Tracking in Glioma Surgery

Abstract

Comparing preoperative and intraoperative fiber tracking visualizes a marked shifting and deformation of major white matter tracts because of tumor removal. This shifting emphasizes the need for an intraoperative update of navigation systems during resection of deep-seated tumor portions near eloquent brain areas. Fiber tracking is a method not only for preoperative neurosurgical visualization but also for further intraoperative planning.

Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery

“…15, [73][74][75]105,106 However, the reconstruction of subcortical fiber tracts from diffusion tensor vectors is a purely anatomical imaging analysis that does not include true electrophysiological functional data.…”

“…2,5,8,73,78,106 Various studies have investigated the accuracy of pre-and intraoperative DTI-FT compared with intraoperative SCS mapping of the motor pathways, which revealed mostly good intraoperative correlations of DTI-FT and SCS, depending on intraoperative brain shift. 78,81,127,128 The sensitivity of CST detection was 95% in a series by Bello et al, 6 and the sensitivity was 93% at a specificity of 93% in a series by Zhu et al Several reports have shown that especially in LGGs, fibers were frequently located inside the tumor, and DTI-FT was able to visualize these fibers.…”

“…74 Thus, DTI-FT is a valuable additional tool for preoperative planning, but it requires a strict control modality when used intraoperatively within the navigation systems during resection of tumors close to the CST; that control is intraoperative electrical stimulation mapping. 74,83,127 The introduction of nTMS in neurosurgical planning led to the fusion of the neurophysiologically based nTMS motor mapping and DTI-FT as a pure imaging technique by using the motor cortex as outlined by nTMS as a seed region for DTI-FT. Two recently reported studies have investigated this approach and both found a higher grade of standardization of DTI-FT when combined with nTMS. 29,46 Moreover, this technique can be used to clarify highly impaired and unclear functional anatomy prior to surgery and enable the surgeon to get a better understanding of the essential structures, which have to be preserved (Fig.…”

3-T ultrahigh-field intraoperative MRI for low-grade glioma resection

“…Previous studies using low-field imaging had already shown that complications, such as intraoperative bleeding could be demonstrated using ioMRI [20]. With the use of high-and ultrahigh-field ioMRI, intraoperative diffusion tensor imaging was also performed to visualize the corticospinal tract [21,22]. All of these technologies are still being validated, investigated further and undergoing refinement, and their impact on long-term patient outcome and quality of life still needs to be investigated.…”

“…The conclusions after 10 years of experience with ioMRI for neurosurgery are as follows [2,5,8,9,11,13,14,17,[21][22][23][24][25][26]. Current ioMRI technology has very high anatomical resolution but also provides functional information (e.g., functional MRI, DWI, magnetic resonance spectroscopy, diffusion tensor imaging, magnetic resonance angiography and magnetic resonance venography).…”