title: Improved delineation of glioma margins and regions of infiltration with the use of diffusion tensor imaging: an image-guided biopsy study.
abstract: OBJECTIVE
  The efficacy of radiation therapy, the mainstay of treatment for malignant gliomas, is limited by our inability to accurately determine tumor margins. As a result, despite recent advances, the prognosis remains appalling. Because gliomas preferentially infiltrate along white matter tracks, methods that show white matter disruption should improve this delineation. In this study, results of histologic examination from samples obtained from image-guided brain biopsies were correlated with diffusion tensor images.
  
  
  METHODS
  Twenty patients requiring image-guided biopsies for presumed gliomas were imaged preoperatively. Patients underwent image-guided biopsies with multiple biopsies taken along a single track that went into normal-appearing brain. Regions of interest were determined from the sites of the biopsies, and diffusion tensor imaging findings were compared with glioma histology.
  
  
  RESULTS
  Using diffusion tissue signatures, it was possible to differentiate gross tumor (reduction of the anisotropic component, q > 12% from contralateral region), from tumor infiltration (increase in the isotropic component, p > 10% from contralateral region). This technique has a sensitivity of 98% and specificity of 81%. T2-weighted abnormalities failed to identify the margin in half of all specimens.
  
  
  CONCLUSIONS
  Diffusion tensor imaging can better delineate the tumor margin in gliomas. Such techniques can improve the delineation of the radiation therapy target volume for gliomas and potentially can direct local therapies for tumor infiltration.
authors.affiliation: Academic Neurosurgical Unit and Wolfson Brain Imaging Centre, Department pf Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom. sjp58@cam.ac.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Price
authors.forename: R
authors.initials: R
authors.lastname: Jena
authors.forename: N G
authors.initials: NG
authors.lastname: Burnet
authors.forename: P J
authors.initials: PJ
authors.lastname: Hutchinson
authors.forename: A F
authors.initials: AF
authors.lastname: Dean
authors.forename: A
authors.initials: A
authors.lastname: Peña
authors.forename: J D
authors.initials: JD
authors.lastname: Pickard
authors.forename: T A
authors.initials: TA
authors.lastname: Carpenter
authors.forename: J H
authors.initials: JH
authors.lastname: Gillard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016880:Anisotropy; D001706:Biopsy; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D005910:Glioma / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D038361:Neuronavigation; D012680:Sensitivity and Specificity; D013238:Stereotaxic Techniques