Abstract
In the last 20 years advances in Neurosurgery, Neuroradiology and Neuro-Oncology have dramatically changed management of brain tumors, especially of gliomas that are seated in eloquent areas and are carrying a higher risk for permanent postoperative neurological deficits.
This chapter aims to provide practical and clinically relevant information with a review of the current literature from glioma biology through MR diffusion basic principles, methodology and clinical application of MR tractography, so that the reader can get a throughout interdisciplinary impression of the state of the art.
In contrast to brain metastases and meningiomas, gliomas extensively infiltrate the extracellular space of the gray and white matter changing the anatomic and functional properties of the brain. MR diffusion imaging has great potentials to contribute to disclose the mechanisms of interaction between gliomas and the host tissue.
Diffusion tensor imaging (DTI) is the most established and validated clinical application of MR tractography and it is increasingly requested by neurosurgeons. More advanced diffusion MR acquisition schemes such as high-angular resolution diffusion imaging (HARDI) and more sophisticated tractography algorithms such as spherical deconvolution (SD) and Q-ball imaging (QBI) have been developed to overcome DTI limitations. The community is beginning to apply the advanced methods in presurgical mapping.
A detailed understanding of the relationship between eloquent white matter fascicles and infiltrating gliomas is mandatory to correctly planning a resection and interpret the functional neurophysiological responses recorded during intraoperative monitoring (IOM) with electromyography (EMG), motor evoked potential (MEP), and direct intraoperative electrical stimulation (IES). It should be emphasized that MR diffusion tractography provides anatomical, not functional information.
The neurosurgical community is increasingly recognizing the value of MR diffusion imaging with tractography in evaluating patients with gliomas. MR tractography is a great educational tool for neurosurgeons and neuroradiologists. Presurgical visualization of eloquent fascicles in the proximity of a mass has been associated with a higher probability of total resection in low and high grade gliomas. Postoperative MR tractography is increasingly used to correlate postoperative deficits with white matter anatomy, and guide rehabilitation strategies.
This chapter presents optimized clinical presurgical HARDI protocols and tractography methods for visualization of the major white matter tracts that are part of the motor, language and visuospatial attention systems. Practical examples of how to interpret MR tractography findings are given, illustrative cases with typical and atypical presurgical findings are presented. Complementary applications with functional MR imaging (fMRI) are highlighted. Finally, the clinical value and limitations of presurgical MR diffusion imaging are discussed.
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Abbreviations
- AC:
-
Anterior commissure
- ADC:
-
Apparent diffusion coefficient
- AF:
-
Arcuate fasciculus
- AG:
-
Angular gyrus
- ALA:
-
5-Aminolevulinic acid
- BA:
-
Brodmann area
- BOLD:
-
Blood oxygenated level dependent
- CC:
-
Corpus callosum
- CL:
-
Linear anisotropy coefficient
- CP:
-
Planar anisotropy coefficient
- CST:
-
Corticospinal tract
- DEC:
-
Directionally encoded color
- dlPFC:
-
Dorsolateral prefrontal cortex
- dODF:
-
Diffusion orientation distribution function
- DSI:
-
Diffusion spectrum imaging
- DTI:
-
Diffusion tensor imaging
- DWI:
-
Diffusion weighted imaging
- ECS:
-
Extracellular space
- EOR:
-
Extent of resection
- EPI:
-
Echo planar imaging
- FA:
-
Fractional anisotropy
- FAT:
-
Frontal aslant tract
- FEF:
-
Frontal eye field
- FLAIR:
-
Fluid attenuated inversion recovery
- fMRI:
-
Functional magnetic resonance imaging
- fODF:
-
Fiber orientation diffusion function
- FST:
-
Frontal striatal tract
- GBM:
-
Glioblastoma multiforme
- HARDI:
-
High-angular resolution diffusion imaging
- HGG:
-
High grade glioma
- IES:
-
Intraoperative electrical stimulation
- IFG:
-
Inferior frontal gyrus
- IFOF:
-
Inferior frontal occipital fasciculus
- ILF:
-
Inferior longitudinal fasciculus
- IOM:
-
Intraoperative monitoring
- IPL:
-
Inferior parietal lobule
- ITG:
-
Inferior temporal gyrus
- LGG:
-
Low grade glioma
- M1:
-
Primary motor cortex
- MD:
-
Mean diffusivity
- MEP:
-
Notor evoked potential
- MFG:
-
Medial frontal gyrus
- MLF:
-
Medial longitudinal fasciculus
- MRI:
-
Magnetic resonance imaging
- MTG:
-
Medial temporal gyrus
- ND:
-
Neurite density
- NODDI:
-
Neurite orientation dispersion and density imaging
- ODI:
-
Orientation dispersion index
- OR:
-
Optic radiations
- PMC:
-
Premotor cortex
- PMd:
-
Premotor dorsal
- PMv:
-
Premotor ventral
- PPC:
-
Posterior parietal cortex
- QBI:
-
Q-ball imaging
- ROI:
-
Region of interest
- S1:
-
Primary somatosensory cortex
- SC:
-
Spherical anisotropy coefficient
- SCF:
-
Subcallosal fasciculus
- SD:
-
Spherical deconvolution
- SFG:
-
Superior frontal gyrus
- SLF:
-
Superior longitudinal fasciculus
- SMA:
-
Supplementary motor area
- SMG:
-
Supramarginal gyrus
- SPL:
-
Superior parietal lobule
- STG:
-
Superior temporal gyrus
- T2WI:
-
T2-weighted image
- TPFIA:
-
Temporo-parietal fiber intersection area
- UF:
-
Uncinate fasciculus
- vlPFC:
-
Ventrolateral prefrontal cortex
- WHO:
-
World Health Organization
- WM:
-
White matter
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Bizzi, A. (2022). Diffusion Imaging with MR Tractography for Brain Tumor Surgery. In: Stippich, C. (eds) Clinical Functional MRI. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-83343-5_7
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