A Simplified Method of Accurate Postprocessing of Diffusion Tensor Imaging for Use in Brain Tumor Resection
A Simplified Method of Accurate Postprocessing of Diffusion Tensor Imaging for Use in Brain Tumor Resection
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DOI：
10.1227/neu.0000000000001181
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发表时间：
2017-02-01
影响因子：
2.3
通讯作者：
Sughrue, Michael E.
中科院分区：
文献类型：
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作者：
Bonney, Phillip A.;Conner, Andrew K.;Sughrue, Michael E.
背景：扩散张量成像 (DTI) 在脑肿瘤切除中的使用部分受到神经外科实践中实施该技术的困难的限制。目的：演示一种无需神经科学家即可进行的简单 DTI 后处理方法，并分享在积极切除肿瘤的同时保留患者功能的结果。方法：从所有肿瘤位于假定的功能皮质内的患者中获得 DTI 数据。非专家可在 20 分钟内绘制相关白质束图并通过神经导航进行整合。我们报告了2014年1月至2014年12月连续43例清醒开颅手术患者接受颅内病灶切除术的手术结果。我们将 DTI 预期结果与皮质脊髓束、上纵束和额枕下束的刺激标测结果进行比较。 结果：28 名患者 (65%) 接受了高级别胶质瘤手术，11 名患者 (26%) 接受了低级别胶质瘤手术。 17 名患者有后颞部病变； 10 名有后额部病变； 8 例有顶颞枕交界处病变； 8 例有岛叶病变。以 DTI 定义的束作为指导，通过刺激绘图发现了 65 个阳性图和 60 个阴性图。 DTI 的总体敏感性和特异性分别为 98% 和 95%。 1 名患者（2%）出现永久性言语恶化，3 名患者（7%）出现永久性无力。 32 例 (74%) 的切除率超过 90%。结论：准确的 DTI 很容易获得、后处理并在常规神经外科工作流程中应用于神经导航。这些信息有助于切除肿瘤，同时保留雄辩的皮质和皮质下网络。
BACKGROUND: Use of diffusion tensor imaging (DTI) in brain tumor resection has been limited in part by a perceived difficulty in implementing the techniques into neurosurgical practice.OBJECTIVE: To demonstrate a simple DTI postprocessing method performed without a neuroscientist and to share results in preserving patient function while aggressively resecting tumors.METHODS: DTI data are obtained in all patients with tumors located within presumed eloquent cortices. Relevant white matter tracts are mapped and integrated with neuronavigation by a nonexpert in < 20 minutes. We report operative results in 43 consecutive awake craniotomy patients from January 2014 to December 2014 undergoing resection of intracranial lesions. We compare DTI-expected findings with stimulation mapping results for the corticospinal tract, superior longitudinal fasciculus, and inferior fronto-occipital fasciculus.RESULTS: Twenty-eight patients (65%) underwent surgery for high-grade gliomas and 11 patients (26%) for low-grade gliomas. Seventeen patients had posterior temporal lesions; 10 had posterior frontal lesions; 8 had parietal-temporal-occipital junction lesions; and 8 had insular lesions. With DTI-defined tracts used as a guide, a combined 65 positive maps and 60 negative maps were found via stimulation mapping. Overall sensitivity and specificity of DTI were 98% and 95%, respectively. Permanent speech worsening occurred in 1 patient (2%), and permanent weakness occurred in 3 patients (7%). Greater than 90% resection was achieved in 32 cases (74%).CONCLUSION: Accurate DTI is easily obtained, postprocessed, and implemented into neuronavigation within routine neurosurgical workflow. This information aids in resecting tumors while preserving eloquent cortices and subcortical networks.