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Weiß L, Roth F, Rea-Ludmann P, Rosenstock T, Picht T, Vajkoczy P, Zdunczyk A. NTMS based tractography and segmental diffusion analysis in patients with brainstem gliomas: Risk stratification and clinical potential. BRAIN & SPINE 2024; 4:102753. [PMID: 38510608 PMCID: PMC10951762 DOI: 10.1016/j.bas.2024.102753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction Surgery on the brainstem level is associated with a high-risk of postoperative morbidity. Recently, we have introduced the combination of navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) tractography to define functionally relevant motor fibers tracts on the brainstem level to support operative planning and risk stratification in brainstem cavernomas. Research question Evaluate this method and assess it's clinical impact for the surgery of brainstem gliomas. Material and methods Patients with brainstem gliomas were examined preoperatively with motor nTMS and DTI tractography. A fractional anisotropy (FA) value of 75% of the individual FA threshold (FAT) was used to track descending corticospinal (CST) and -bulbar tracts (CBT). The distance between the tumor and the somatotopic tracts (hand, leg, face) was measured and diffusion parameters were correlated to the patients' outcome. Results 12 patients were enrolled in this study, of which 6 underwent surgical resection, 5 received a stereotactic biopsy and 1 patient received conservative treatment. In all patients nTMS mapping and somatotopic tractography were performed successfully. Low FA values correlated with clinical symptoms revealing tract alteration by the tumor (p = 0.049). A tumor-tract distance (TTD) above 2 mm was the critical limit to achieve a safe complete tumor resection. Discussion and conclusion nTMS based DTI tractography combined with local diffusion analysis is a valuable tool for preoperative visualization and functional assessment of relevant motor fiber tracts, improving planning of safe entry corridors and perioperative risk stratification in brainstem gliomas tumors. This technique allows for customized treatment strategy to maximize patients' safety.
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Affiliation(s)
- Lion Weiß
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| | - Fabia Roth
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| | - Pierre Rea-Ludmann
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| | - Tizian Rosenstock
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany
| | - Thomas Picht
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
- Cluster of Excellence Matters of Activity. Image Space Material, Humboldt Universität zu Berlin, Germany
| | - Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| | - Anna Zdunczyk
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
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Mirbagheri S, Kamali A, Cai C, Kasaie P, Pillai JJ, Gujar SK, Khorsandi A, Sair HI. Quantitative assessment of changes in diffusion tensor imaging (DTI) metrics along the courses of the cortico-ponto-cerebellar tracts secondary to supratentorial human brain glial tumors. Cancer Rep (Hoboken) 2018; 1:e1108. [PMID: 32721087 DOI: 10.1002/cnr2.1108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The cortico-ponto-cerebellar tract (CPCT) is the largest projection pathway, which synapses at the pons. Remote effects of supratentorial brain tumors have not been evaluated along the infratentorial course of the CPCT. AIM The purpose of this study is to evaluate the possible lateralization of the diffusion tensor metrics of the affected CPCT in patients with supratentorial brain tumor. METHODS AND RESULTS We included 39 patients with 29 left-sided tumors (LST) and 10 right-sided tumors, retrospectively. We measured the magnitude of changes of the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the CPCT prior to the brain surgery at the level of crus cerebri and middle cerebellar peduncle. Regions of interest (ROIs) were placed on the lateral side of crus cerebri, and ROI-1 (anterior 1/3), ROI-2 (middle 1/3), ROI-3 (posterior 1/3), and ROI-4 were placed at the level of middle cerebellar peduncle. We hypothesized that there would be decreased FA and increased ADC values of the ipsilesional CPCT compared with contralesional CPCT. Ipsilesional FA values were decreased with simultaneous increased ADC value along the CPCT compared with contralesional CPCT in following ROIs, ROI-1 (LST FA: P = .005, ADC: P = .037) and ROI-3 (LST FA: P = .049, ADC: P = .049), respectively. Affected ROI-4 in LST cases also showed lower FA values, although not statistically significant. CONCLUSION We observed a statistically significant FA value decrease and ADC increase along the left ROI-1 and ROI-3 as well as the nonstatistically significant FA decrease of the left ROI-4 at the second neuron level when there was a related supratentorial tumor. These findings are suggestive of presynaptic and postsynaptic microstructural changes of these tracts following the presynaptic involvement by a primary supratentorial brain tumor.
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Affiliation(s)
- Saeedeh Mirbagheri
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Arash Kamali
- Department of Diagnostic & Interventional Imaging, University of Texas Houston Medical School, Memorial Hermann Hospital, Houston, TX, USA
| | - Chunyan Cai
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Parastu Kasaie
- Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Jay Jan Pillai
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sachin Krishnakant Gujar
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Haris Iqbal Sair
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
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Suh CH, Kim HS, Jung SC, Kim SJ. Diffusion-Weighted Imaging and Diffusion Tensor Imaging for Differentiating High-Grade Glioma from Solitary Brain Metastasis: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:1208-1214. [PMID: 29724766 DOI: 10.3174/ajnr.a5650] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/07/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Accurate diagnosis of high-grade glioma and solitary brain metastasis is clinically important because it affects the patient's outcome and alters patient management. PURPOSE To evaluate the diagnostic performance of DWI and DTI for differentiating high-grade glioma from solitary brain metastasis. DATA SOURCES A literature search of Ovid MEDLINE and EMBASE was conducted up to November 10, 2017. STUDY SELECTION Studies evaluating the diagnostic performance of DWI and DTI for differentiating high-grade glioma from solitary brain metastasis were selected. DATA ANALYSIS Summary sensitivity and specificity were established by hierarchic logistic regression modeling. Multiple subgroup analyses were also performed. DATA SYNTHESIS Fourteen studies with 1143 patients were included. The individual sensitivities and specificities of the 14 included studies showed a wide variation, ranging from 46.2% to 96.0% for sensitivity and 40.0% to 100.0% for specificity. The pooled sensitivity of both DWI and DTI was 79.8% (95% CI, 70.9%-86.4%), and the pooled specificity was 80.9% (95% CI, 75.1%-85.5%). The area under the hierarchical summary receiver operating characteristic curve was 0.87 (95% CI, 0.84-0.89). The multiple subgroup analyses also demonstrated similar diagnostic performances (sensitivities of 76.8%-84.7% and specificities of 79.7%-84.0%). There was some level of heterogeneity across the included studies (I2 = 36%); however, it did not reach a level of concern. LIMITATIONS The included studies used various DWI and DTI parameters. CONCLUSIONS DWI and DTI demonstrated a moderate diagnostic performance for differentiation of high-grade glioma from solitary brain metastasis.
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Affiliation(s)
- C H Suh
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - H S Kim
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - S C Jung
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S J Kim
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Gao B, Shen X, Shiroishi MS, Pang M, Li Z, Yu B, Shen G. A pilot study of pre-operative motor dysfunction from gliomas in the region of corticospinal tract: Evaluation with diffusion tensor imaging. PLoS One 2017; 12:e0182795. [PMID: 28829841 PMCID: PMC5568729 DOI: 10.1371/journal.pone.0182795] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 07/25/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Brain tumors in the corticospinal tract (CST) region are more likely to cause motor dysfunction. The aim of this study is to evaluate the effect of gliomas located in the CST region on motor function with diffusion tensor imaging (DTI) preoperatively. MATERIALS AND METHODS Forty-five patients with histopathologically confirmed gliomas were included in this pilot study, in all cases (low-grade n = 13, high-grade n = 32) CST but not the motor cortex were involved by the tumor. DTI image were acquired and the posterior limb of the internal capsule fractional anisotropy (FA) and relative FA (rFA = affected FA/contralateral FA) were measured. Injury of the CST from tumor was divided into three grades (grade 1: displacement, grade 2: displacement and infiltration, grade 3: displacement and disruption). The fiber density index (FDi) and relative FDi (rFDi = affected FDi/contralateral FDi) of the injured and contralateral CST were measured. The correlations between muscle strength and the CST injury grade and the rFA, affected FDi, rFDi values were calculated using Spearman rank correlation analysis. rFA and rFDi values of muscle strength groups (MMT2-5) were compared with one-way analysis of variance (ANOVA). The difference of muscle strength between low- and high-grade glioma groups were analysed with the Mann-Whitney U-test. RESULTS Muscle strength was negatively correlated with the injury grade of the CST (r = -0.840, P<0.001). Muscle strength was positively correlated with rFA, FDi and rFDi (correlation coefficients (r) were 0.615, 0.643 and 0.567 for rFA, FDi and rFDi, respectively). The rFA values between grades (2&3, 2&4, 2&5, 3&5, 4&5) of muscle strength were significantly different (P<0.05), the rFDi values between grades (2&4, 2&5, 3&4, 3&5) of muscle strength were significantly different (P<0.05), while the rFA and rFDi values in the remaining groups of muscle strength grades showed no significant differences(P>0.05). CONCLUSIONS Preoperative DTI and diffusion tensor tractography may quantify the injury degrees of CST and the extent of motor dysfunction in patients with brain glioma.
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Affiliation(s)
- Bo Gao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, People’s Republic of China
| | - Xudong Shen
- Department of Radiology, Enshi Central Hospital, Enshi, Hubei, People’s Republic of China
| | - Mark S. Shiroishi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Mingfan Pang
- Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zhiqian Li
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Benxia Yu
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, People’s Republic of China
- * E-mail: (GS); (BY)
| | - Guiquan Shen
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
- * E-mail: (GS); (BY)
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Rosenstock T, Giampiccolo D, Schneider H, Runge SJ, Bährend I, Vajkoczy P, Picht T. Specific DTI seeding and diffusivity-analysis improve the quality and prognostic value of TMS-based deterministic DTI of the pyramidal tract. NEUROIMAGE-CLINICAL 2017; 16:276-285. [PMID: 28840099 PMCID: PMC5560117 DOI: 10.1016/j.nicl.2017.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/22/2017] [Accepted: 08/11/2017] [Indexed: 12/17/2022]
Abstract
Object Navigated transcranial magnetic stimulation (nTMS) combined with diffusion tensor imaging (DTI) is used preoperatively in patients with eloquent-located brain lesions and allows analyzing non-invasively the spatial relationship between the tumor and functional areas (e.g. the motor cortex and the corticospinal tract [CST]). In this study, we examined the diffusion parameters FA (fractional anisotropy) and ADC (apparent diffusion coefficient) within the CST in different locations and analyzed their interrater reliability and usefulness for predicting the patients' motor outcome with a precise approach of specific region of interest (ROI) seeding based on the color-coded FA-map. Methods Prospectively collected data of 30 patients undergoing bihemispheric nTMS mapping followed by nTMS-based DTI fiber tracking prior to surgery of motor eloquent high-grade gliomas were analyzed by 2 experienced and 1 unexperienced examiner. The following data were scrutinized for both hemispheres after tractography based on nTMS-motor positive cortical seeds and a 2nd region of interest in one layer of the caudal pons defined by the color-coded FA-map: the pre- and postoperative motor status (day of discharge und 3 months), the closest distance between the tracts and the tumor (TTD), the fractional anisotropy (FA) and the apparent diffusion coefficient (ADC). The latter as an average within the CST as well as specific values in different locations (peritumoral, mesencephal, pontine). Results Lower average FA-values within the affected CST as well as higher average ADC-values are significantly associated with deteriorated postoperative motor function (p = 0.006 and p = 0.026 respectively). Segmental analysis within the CST revealed that the diffusion parameters are especially disturbed on a peritumoral level and that the degree of their impairment correlates with motor deficits (FA p = 0.065, ADC p = 0.007). No significant segmental variation was seen in the healthy hemisphere. The interrater reliability showed perfect agreement for almost all analyzed parameters. Conclusions Adding diffusion weighted imaging derived information on the structural integrity of the nTMS-based tractography results improves the predictive power for postoperative motor outcome. Utilizing a second subcortical ROI which is specifically seeded based on the color-coded FA map increases the tracking quality of the CST independently of the examiner's experience. Further prospective studies are needed to validate the nTMS-based prediction of the patient's outcome. ROI seeding based on nTMS-data and FA-maps improves DTI tractography of the CST. Perfect interrater reliability for DTI tractography of the CST was observed. The pattern of diffusivity disturbance predicts the postoperative motor outcome.
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Affiliation(s)
- Tizian Rosenstock
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Davide Giampiccolo
- Institute of Neurosurgery, University Hospital, Piazzale Stefani 1, 37100 Verona, Italy
| | - Heike Schneider
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophia Jutta Runge
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
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Raffa G, Bährend I, Schneider H, Faust K, Germanò A, Vajkoczy P, Picht T. A Novel Technique for Region and Linguistic Specific nTMS-based DTI Fiber Tracking of Language Pathways in Brain Tumor Patients. Front Neurosci 2016; 10:552. [PMID: 27994536 PMCID: PMC5134322 DOI: 10.3389/fnins.2016.00552] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 11/16/2016] [Indexed: 12/03/2022] Open
Abstract
Navigated transcranial magnetic stimulation (nTMS) has recently been introduced as a non-invasive tool for functional mapping of cortical language areas prior to surgery. It correlates well with intraoperative neurophysiological monitoring (IONM) findings, allowing defining the best surgical strategy to preserve cortical language areas during surgery for language-eloquent tumors. Nevertheless, nTMS allows only for cortical mapping and postoperative language deficits are often caused by injury to subcortical language pathways. Nowadays, the only way to preoperatively visualize language subcortical white matter tracts consists in DTI fiber tracking (DTI-FT). However, standard DTI-FT is based on anatomical landmarks that vary interindividually and can be obscured by the presence of the tumor itself. It has been demonstrated that combining nTMS with DTI-FT allows for a more reliable visualization of the motor pathway in brain tumor patients. Nevertheless, no description about such a combination has been reported for the language network. The aim of the present study is to describe and assess the feasibility and reliability of using cortical seeding areas defined by error type-specific nTMS language mapping (nTMS-positive spots) to perform DTI-FT in patients affected by language-eloquent brain tumors. We describe a novel technique for a nTMS-based DTI-FT to visualize the complex cortico-subcortical connections of the language network. We analyzed quantitative findings, such as fractional anisotropy values and ratios, and the number of visualized connections of nTMS-positive spots with subcortical pathways, and we compared them with results obtained by using the standard DTI-FT technique. We also analyzed the functional concordance between connected cortical nTMS-positive spots and subcortical pathways, and the likelihood of connection for nTMS-positive vs. nTMS-negative cortical spots. We demonstrated, that the nTMS-based approach, especially what we call the “single-spot” strategy, is able to provide a reliable and more detailed reconstruction of the complex cortico-subcortical language network as compared to the standard DTI-FT. We believe this technique represents a beneficial new strategy for customized preoperative planning in patients affected by tumors in presumed language eloquent location, providing anatomo-functional information to plan language-preserving surgery.
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Affiliation(s)
- Giovanni Raffa
- Department of Clinical and Experimental Medicine, University of MessinaMessina, Italy; Neurosurgical Clinic, Department of Neuroscience, University of MessinaMessina, Italy
| | - Ina Bährend
- Department of Neurosurgery, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Heike Schneider
- Department of Neurosurgery, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Antonino Germanò
- Neurosurgical Clinic, Department of Neuroscience, University of Messina Messina, Italy
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité Universitätsmedizin BerlinBerlin, Germany; Cluster of Excellence: "Image Knowledge Gestaltung: An Interdisciplinary Laboratory", Humboldt UniversityBerlin, Germany
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Weiss Lucas C, Tursunova I, Neuschmelting V, Nettekoven C, Oros-Peusquens AM, Stoffels G, Faymonville AM, Jon SN, Langen KJ, Lockau H, Goldbrunner R, Grefkes C. Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract. NEUROIMAGE-CLINICAL 2016; 13:297-309. [PMID: 28050345 PMCID: PMC5192048 DOI: 10.1016/j.nicl.2016.11.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND DTI-based tractography is an increasingly important tool for planning brain surgery in patients suffering from brain tumours. However, there is an ongoing debate which tracking approaches yield the most valid results. Especially the use of functional localizer data such as navigated transcranial magnetic stimulation (nTMS) or functional magnetic resonance imaging (fMRI) seem to improve fibre tracking data in conditions where anatomical landmarks are less informative due to tumour-induced distortions of the gyral anatomy. We here compared which of the two localizer techniques yields more plausible results with respect to mapping different functional portions of the corticospinal tract (CST) in brain tumour patients. METHODS The CSTs of 18 patients with intracranial tumours in the vicinity of the primary motor area (M1) were investigated by means of deterministic DTI. The core zone of the tumour-adjacent hand, foot and/or tongue M1 representation served as cortical regions of interest (ROIs). M1 core zones were defined by both the nTMS hot-spots and the fMRI local activation maxima. In addition, for all patients, a subcortical ROI at the level of the inferior anterior pons was implemented into the tracking algorithm in order to improve the anatomical specificity of CST reconstructions. As intra-individual control, we additionally tracked the CST of the hand motor region of the unaffected, i.e., non-lesional hemisphere, again comparing fMRI and nTMS M1 seeds. The plausibility of the fMRI-ROI- vs. nTMS-ROI-based fibre trajectories was assessed by a-priori defined anatomical criteria. Moreover, the anatomical relationship of different fibre courses was compared regarding their distribution in the anterior-posterior direction as well as their location within the posterior limb of the internal capsule (PLIC). RESULTS Overall, higher plausibility rates were observed for the use of nTMS- as compared to fMRI-defined cortical ROIs (p < 0.05) in tumour vicinity. On the non-lesional hemisphere, however, equally good plausibility rates (100%) were observed for both localizer techniques. fMRI-originated fibres generally followed a more posterior course relative to the nTMS-based tracts (p < 0.01) in both the lesional and non-lesional hemisphere. CONCLUSION NTMS achieved better tracking results than fMRI in conditions when the cortical tract origin (M1) was located in close vicinity to a brain tumour, probably influencing neurovascular coupling. Hence, especially in situations with altered BOLD signal physiology, nTMS seems to be the method of choice in order to identify seed regions for CST mapping in patients.
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Key Words
- APB, Abductor pollicis brevis muscle
- BOLD, Blood-oxygenation-level dependent
- CST
- CST, Corticospinal tract
- DCS, Direct cortical stimulation
- DTI, Diffusion tensor imaging
- Deterministic
- EF, Electric field
- EMG, Electromyography
- FA(T), Fractional anisotropy (threshold)
- FACT, Fibre assignment by continuous tracking
- FOV, Field-of-view
- FWE, Family-wise error
- KPS, Karnofsky performance scale
- LT, Lateral tongue muscle, anterior third
- M1, Primary motor cortex
- MEP, Motor-evoked potential
- MFL, Minimal fibre length
- MPRAGE, Magnetization prepared rapid acquisition gradient echo (T1 MR seq.)
- OR, Odd's ratio
- PLIC, Posterior limb of the internal capsule
- PM, Plantar muscle
- Pyramidal tract
- RMT, Resting motor threshold
- ROI
- ROI, Region-of-interest
- SD, Standard deviation
- SE, Standard error
- Somatotopic
- X-sq, X-squared (Pearson's chi-square test)
- dMRI, Diffusion magnetic resonance imaging (i.e., diffusion-weighted imaging, DWI)
- fMRI
- fMRI, Functional magnetic resonance imaging
- nTMS
- nTMS, Neuronavigated transcranial magnetic stimulation
- pxsq, p-value according to Pearson's chi-square test
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Affiliation(s)
| | - Irada Tursunova
- University of Cologne, Center of Neurosurgery, 50924 Cologne, Germany
| | | | | | | | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany
| | | | - Shah N Jon
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; RWTH Aachen University, University Clinic Aachen, Departments of Nuclear Medicine and Neurology, 52074 Aachen, Germany; Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia; Monash Institute of Medical Engineering, Monash University, Melbourne, Victoria, Australia; Monash Biomedical Imaging, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Karl Josef Langen
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; RWTH Aachen University, University Clinic Aachen, Departments of Nuclear Medicine and Neurology, 52074 Aachen, Germany
| | - Hannah Lockau
- University of Cologne, Department of Radiology, 50937 Cologne, Germany
| | | | - Christian Grefkes
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; University of Cologne, Department of Neurology, 50924 Cologne, Germany
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Weiss C, Tursunova I, Neuschmelting V, Lockau H, Nettekoven C, Oros-Peusquens AM, Stoffels G, Rehme AK, Faymonville AM, Shah NJ, Langen KJ, Goldbrunner R, Grefkes C. Improved nTMS- and DTI-derived CST tractography through anatomical ROI seeding on anterior pontine level compared to internal capsule. NEUROIMAGE-CLINICAL 2015; 7:424-37. [PMID: 25685709 PMCID: PMC4314616 DOI: 10.1016/j.nicl.2015.01.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 12/16/2022]
Abstract
Imaging of the course of the corticospinal tract (CST) by diffusion tensor imaging (DTI) is useful for function-preserving tumour surgery. The integration of functional localizer data into tracking algorithms offers to establish a direct structure–function relationship in DTI data. However, alterations of MRI signals in and adjacent to brain tumours often lead to spurious tracking results. We here compared the impact of subcortical seed regions placed at different positions and the influences of the somatotopic location of the cortical seed and clinical co-factors on fibre tracking plausibility in brain tumour patients. The CST of 32 patients with intracranial tumours was investigated by means of deterministic DTI and neuronavigated transcranial magnetic stimulation (nTMS). The cortical seeds were defined by the nTMS hot spots of the primary motor area (M1) of the hand, the foot and the tongue representation. The CST originating from the contralesional M1 hand area was mapped as intra-individual reference. As subcortical region of interests (ROI), we used the posterior limb of the internal capsule (PLIC) and/or the anterior inferior pontine region (aiP). The plausibility of the fibre trajectories was assessed by a-priori defined anatomical criteria. The following potential co-factors were analysed: Karnofsky Performance Scale (KPS), resting motor threshold (RMT), T1-CE tumour volume, T2 oedema volume, presence of oedema within the PLIC, the fractional anisotropy threshold (FAT) to elicit a minimum amount of fibres and the minimal fibre length. The results showed a higher proportion of plausible fibre tracts for the aiP-ROI compared to the PLIC-ROI. Low FAT values and the presence of peritumoural oedema within the PLIC led to less plausible fibre tracking results. Most plausible results were obtained when the FAT ranged above a cut-off of 0.105. In addition, there was a strong effect of somatotopic location of the seed ROI; best plausibility was obtained for the contralateral hand CST (100%), followed by the ipsilesional hand CST (>95%), the ipsilesional foot (>85%) and tongue (>75%) CST. In summary, we found that the aiP-ROI yielded better tracking results compared to the IC-ROI when using deterministic CST tractography in brain tumour patients, especially when the M1 hand area was tracked. In case of FAT values lower than 0.10, the result of the respective CST tractography should be interpreted with caution with respect to spurious tracking results. Moreover, the presence of oedema within the internal capsule should be considered a negative predictor for plausible CST tracking. Somatotopic CST tractography was done in 32 patients with eloquent brain tumours. Seeding ROIs were defined by navigated TMS of the M1 hot spot (hand, foot, tongue). Using the anterior pons as a second ROI yielded more plausible tracts than the PLIC. Low FAT and oedema of the internal capsule were negative predictors.
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Key Words
- ANOVA, analysis of variance
- APB, abductor pollicis brevis muscle
- AUC, area under the curve
- BOLD, blood oxygenation level dependent
- CST
- CST, corticospinal tract
- DTI
- DTI, diffusion tensor imaging
- FA(T), fractional anisotropy (threshold)
- FACT, fibre assignment by continuous tracking
- FMRI, functional magnetic resonance imaging
- FOV, field-of-view
- FWE, family-wise error
- Fractional anisotropy
- KPS, Karnofsky performance scale
- LDA/C, linear discriminant analysis/coefficient
- LT, lateral tongue muscle, anterior third
- M1, primary motor cortex
- MEP, motor evoked potential
- MFL, minimal fibre length
- MPRAGE, magnetization prepared rapid acquisition gradient echo (T1 MR sequence)
- OR, odd's ratio
- PLIC, posterior limb of the internal capsule
- PM, plantar muscle
- RMT, resting motor threshold
- ROI
- ROI, region-of-interest
- SD, standard deviation
- SE, standard error
- Somatotopic
- X-sq, X-squared (Pearson's chi-square test)
- aiP, anterior inferior pons
- nTMS
- nTMS, neuronavigated transcranial magnetic stimulation
- pxsq, p-value according to Pearson's chi-square test.
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Affiliation(s)
- Carolin Weiss
- Department of Neurosurgery, University of Cologne, Cologne 50924, Germany
| | - Irada Tursunova
- Department of Neurosurgery, University of Cologne, Cologne 50924, Germany ; Department of Neurosurgery, University of Cologne, Cologne 50924, Germany
| | | | - Hannah Lockau
- Department of Radiology, University of Cologne, Cologne 50937, Germany
| | - Charlotte Nettekoven
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany
| | | | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany
| | - Anne K Rehme
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany ; Department of Neurology, University of Cologne, Cologne 50924, Germany
| | | | - N Jon Shah
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany ; Department of Neurology, University Clinic Aachen, RWTH Aachen University, Aachen 52074, Germany
| | - Karl Josef Langen
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany
| | - Roland Goldbrunner
- Department of Neurosurgery, University of Cologne, Cologne 50924, Germany
| | - Christian Grefkes
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany ; Department of Neurology, University of Cologne, Cologne 50924, Germany
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9
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Nicolasjilwan M, Hu Y, Yan C, Meerzaman D, Holder CA, Gutman D, Jain R, Colen R, Rubin DL, Zinn PO, Hwang SN, Raghavan P, Hammoud DA, Scarpace LM, Mikkelsen T, Chen J, Gevaert O, Buetow K, Freymann J, Kirby J, Flanders AE, Wintermark M. Addition of MR imaging features and genetic biomarkers strengthens glioblastoma survival prediction in TCGA patients. J Neuroradiol 2014; 42:212-21. [PMID: 24997477 DOI: 10.1016/j.neurad.2014.02.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/30/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of our study was to assess whether a model combining clinical factors, MR imaging features, and genomics would better predict overall survival of patients with glioblastoma (GBM) than either individual data type. METHODS The study was conducted leveraging The Cancer Genome Atlas (TCGA) effort supported by the National Institutes of Health. Six neuroradiologists reviewed MRI images from The Cancer Imaging Archive (http://cancerimagingarchive.net) of 102 GBM patients using the VASARI scoring system. The patients' clinical and genetic data were obtained from the TCGA website (http://www.cancergenome.nih.gov/). Patient outcome was measured in terms of overall survival time. The association between different categories of biomarkers and survival was evaluated using Cox analysis. RESULTS The features that were significantly associated with survival were: (1) clinical factors: chemotherapy; (2) imaging: proportion of tumor contrast enhancement on MRI; and (3) genomics: HRAS copy number variation. The combination of these three biomarkers resulted in an incremental increase in the strength of prediction of survival, with the model that included clinical, imaging, and genetic variables having the highest predictive accuracy (area under the curve 0.679±0.068, Akaike's information criterion 566.7, P<0.001). CONCLUSION A combination of clinical factors, imaging features, and HRAS copy number variation best predicts survival of patients with GBM.
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Affiliation(s)
- Manal Nicolasjilwan
- Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, United States
| | - Ying Hu
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD, United States
| | - Chunhua Yan
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD, United States
| | - Daoud Meerzaman
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD, United States
| | - Chad A Holder
- Department of Radiology and Imaging Sciences Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA, United States
| | - David Gutman
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - Rajan Jain
- Departments of Radiology and Neurosurgery, Henry Ford, Detroit, MI, United States
| | - Rivka Colen
- Division of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Daniel L Rubin
- Department of Radiology and Medicine (Biomedical Informatics Research), Stanford University, Stanford, CA, United States
| | - Pascal O Zinn
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Scott N Hwang
- Neuroradiology Section, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Prashant Raghavan
- Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, United States
| | - Dima A Hammoud
- Radiology and Imaging Sciences, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Lisa M Scarpace
- Departments of Neurosurgery, Henry Ford, Detroit, MI, United States
| | - Tom Mikkelsen
- Departments of Neurosurgery, Henry Ford, Detroit, MI, United States
| | - James Chen
- Division of Neuroradiology, University of California, San Diego, CA, United States
| | - Olivier Gevaert
- Center for Cancer Systems Biology (CCSB) & Department of Radiology, Stanford University, Stanford, CA, United States
| | - Kenneth Buetow
- Arizona State University Life Science, Tempe, AZ, United States
| | | | - Justin Kirby
- SAIC-Frederick, Inc., Frederick, MD, United States
| | - Adam E Flanders
- Division of Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Max Wintermark
- Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, United States; CHU de Vaudois, Department of Radiology, Lausanne, Switzerland.
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10
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Global diffusion tensor imaging derived metrics differentiate glioblastoma multiforme vs. normal brains by using discriminant analysis: introduction of a novel whole-brain approach. Radiol Oncol 2014; 48:127-36. [PMID: 24991202 PMCID: PMC4078031 DOI: 10.2478/raon-2014-0004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/21/2013] [Indexed: 02/08/2023] Open
Abstract
Background Histological behavior of glioblastoma multiforme suggests it would benefit more from a global rather than regional evaluation. A global (whole-brain) calculation of diffusion tensor imaging (DTI) derived tensor metrics offers a valid method to detect the integrity of white matter structures without missing infiltrated brain areas not seen in conventional sequences. In this study we calculated a predictive model of brain infiltration in patients with glioblastoma using global tensor metrics. Methods Retrospective, case and control study; 11 global DTI-derived tensor metrics were calculated in 27 patients with glioblastoma multiforme and 34 controls: mean diffusivity, fractional anisotropy, pure isotropic diffusion, pure anisotropic diffusion, the total magnitude of the diffusion tensor, linear tensor, planar tensor, spherical tensor, relative anisotropy, axial diffusivity and radial diffusivity. The multivariate discriminant analysis of these variables (including age) with a diagnostic test evaluation was performed. Results The simultaneous analysis of 732 measures from 12 continuous variables in 61 subjects revealed one discriminant model that significantly differentiated normal brains and brains with glioblastoma: Wilks’ λ = 0.324, χ2 (3) = 38.907, p < .001. The overall predictive accuracy was 92.7%. Conclusions We present a phase II study introducing a novel global approach using DTI-derived biomarkers of brain impairment. The final predictive model selected only three metrics: axial diffusivity, spherical tensor and linear tensor. These metrics might be clinically applied for diagnosis, follow-up, and the study of other neurological diseases.
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11
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Jenabi M, Peck KK, Young RJ, Brennan N, Holodny AI. Probabilistic fiber tracking of the language and motor white matter pathways of the supplementary motor area (SMA) in patients with brain tumors. J Neuroradiol 2013; 41:342-9. [PMID: 24380641 DOI: 10.1016/j.neurad.2013.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Accurate localization of anatomically and functionally separate SMA tracts is important to improve planning prior to neurosurgery. Using fMRI and probabilistic DTI techniques, we assessed the connectivity between the frontal language area (Broca's area) and the rostral pre-SMA (language SMA) and caudal SMA proper (motor SMA). MATERIALS AND METHODS Twenty brain tumor patients completed motor and language fMRI paradigms and DTI. Peaks of functional activity in the language SMA, motor SMA and Broca's area were used to define seed regions for probabilistic tractography. RESULTS fMRI and probabilistic tractography identified separate and unique pathways connecting the SMA to Broca's area - the language SMA pathway and the motor SMA pathway. For all subjects, the language SMA pathway had a larger number of voxels (P<0.0001) and higher connectivity (P<0.0001) to Broca's area than did the motor SMA pathway. In each patient, the number of voxels was greater in the language and motor SMA pathways than in background pathways (P<0.0001). No differences were found between patients with ipsilateral and those with contralateral tumors for either the language SMA pathway (degree of connectivity: P<0.36; number of voxels: 0.35) or the motor SMA pathway (degree of connectivity, P<0.28; number of voxels, P<0.74). CONCLUSION Probabilistic tractography can identify unique white matter tracts that connect language SMA and motor SMA to Broca's area. The language SMA is more significantly connected to Broca's area than is the motor subdivision of the SMA proper.
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Affiliation(s)
- Mehrnaz Jenabi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275, York avenue, New York, 10065 NY, USA
| | - Kyung K Peck
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275, York avenue, New York, 10065 NY, USA; Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275, York avenue, New York, 10065 NY, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275, York avenue, New York, 10065 NY, USA; Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, 1275, York avenue, New York, 10065 NY, USA; Department of Radiology, Weill Medical College of Cornell University, New York, 10065 NY, USA
| | - Nicole Brennan
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275, York avenue, New York, 10065 NY, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275, York avenue, New York, 10065 NY, USA; Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, 1275, York avenue, New York, 10065 NY, USA; Department of Radiology, Weill Medical College of Cornell University, New York, 10065 NY, USA.
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