Chunshui Yu MD, Presenter: Nothing to Disclose

Kuncheng Li, Abstract Co-Author: Nothing to Disclose

The aim of this study was to demonstrate the role of diffusion tensor tractography (DTT) in preoperative mapping of eloquent white matter tracts in relation to cerebral tumors and to determine whether this technique is helpful for neurosurgical planning.

16 patients with brain tumors (1 grade 2 astrocytoma, 2 grade 3 astrocytomas, 4 grade 4 glioblastomas, 1 grade 2 oligodendroglioma, 3 grade 3 oligoastrocytomas, 1 Grade 3 ependymoma, 1 malignant lymphoma and 3 metastatic adenocarcinomas ) underwent single shot echo-planar diffusion tensor imaging prior to tumor excision. By using tractography software package, the vital white matter tracts (include pyramidal tract, corpus callosum and optic radiation) were reconstructed and information about the exact location of the lesion with respect to clinically eloquent white matter tracts was obtained in each patient. Then reasonable neurosurgical plan was determined to preserve vital white matter tracts while maximizing tumor resection. After neurosurgery, the diffusion tensor imaging was performed again and associated white matter tracts were evaluated to investigate changes of these structures after surgery.

The exact location of tumor relevant to eloquent white matter tracts could be assessed by DTT in each case. The relationships between lesion and white matter tracts could be divided into three types: simple displacement, displacement with infiltration and disruption. Pyramidal tract was involved in 12 cases, only 1 case was simple displacement with improvement after surgery, 9 cases were displacement with infiltration with reducing degree of displacement in post-operation and other 2 cases were disruption without any improvement by surgery. Corpus callosum was involved in 7 cases, three of them were displacement with infiltration with no improvement after surgery and other 4 cases were partial disruption without improvement either. Optic radiation was involved in 3 cases, all of them belonged to simple displacement with reducing degree of displacement after surgery.

DTT allowed for visualization of white matter tracts and was found to be beneficial in the surgical planning for patients with intrinsic brain tumors.

Yu, C, Li, K, Diffusion Tensor Tractography in Patients with Cerebral Tumors: A Helpful Technique for Neurosurgical Planning.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4407593.html