title: Application of high-definition fiber tractography in the management of supratentorial cavernous malformations: a combined qualitative and quantitative approach.
abstract: BACKGROUND
  High-definition fiber tractography (HDFT), an advanced white matter (WM) imaging technique, was evaluated in the management of supratentorial cavernous malformations.
  
  
  OBJECTIVE
  To investigate the relationship of cavernous malformations to the relevant perilesional WM tracts with HDFT and to characterize associated changes first qualitatively and then quantitatively with our novel imaging measure, quantitative anisotropy (QA).
  
  
  METHODS
  Imaging analysis was carried out by researchers blinded to the clinical details. Contralateral WM tracts were used for comparison. Mean QA values were obtained for whole WM tracts. Qualitatively affected superior longitudinal fasciculus/arcuate fibers and corticospinal tracts were further analyzed with the use of mean QA values for the perilesional segments.
  
  
  RESULTS
  Of 10 patients, HDFT assisted with the decision-making process and the offer of surgical resection in 2 patients, lesion approach and removal in 7 patients, and conservative management in 1 patient. Of 17 analyzed WM tracts, HDFT demonstrated partial disruption in 2 tracts, complete disruption in 2 tracts, a combination of displacement and partial disruption in 1 tract, displacement only in 7 tracts, and no change in 5 tracts. Qualitative changes correlated with clinical symptoms. Mean QA values for the whole WM tracts were similar, with the exception of 1 case demonstrating complete disruption of 2 WM tracts. QA-based perilesional segment analysis was consistent with qualitative data in 5 assessed WM tracts.
  
  
  CONCLUSIONS
  HDFT illustrated the precise spatial relationship of cavernous malformations to multiple WM tracts in a 3-dimensional fashion, optimizing surgical planning, and demonstrated associated disruption and/or displacement, with both occurring perilesionally. These changes were supported by our quantitative marker, which needs further validation.
authors.affiliation: *Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ‡Learning and Research Development Center, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania; §Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania.
authors.forename: Kumar
authors.initials: K
authors.lastname: Abhinav
authors.forename: Sudhir
authors.initials: S
authors.lastname: Pathak
authors.forename: R Mark
authors.initials: RM
authors.lastname: Richardson
authors.forename: Johnathan
authors.initials: J
authors.lastname: Engh
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Fang-Cheng
authors.initials: FC
authors.lastname: Yeh
authors.forename: Robert M
authors.initials: RM
authors.lastname: Friedlander
authors.forename: Juan C
authors.initials: JC
authors.lastname: Fernandez-Miranda
mesh_terms: D000328:Adult; D000368:Aged; D016880:Anisotropy; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000473:pathology; D011712:Pyramidal Tracts / Q000473:pathology* / Q000601:surgery; D055815:Young Adult