title: Preoperative Quantitative MR Tractography Compared with Visual Tract Evaluation in Patients with Neuropathologically Confirmed Gliomas Grades II and III: A Prospective Cohort Study.
abstract: Background and Purpose. Low-grade gliomas show infiltrative growth in white matter tracts. Diffusion tensor tractography can noninvasively assess white matter tracts. The aim was to preoperatively assess tumor growth in white matter tracts using quantitative MR tractography (3T). The hypothesis was that suspected infiltrated tracts would have altered diffusional properties in infiltrated tract segments compared to noninfiltrated tracts. Materials and Methods. Forty-eight patients with suspected low-grade glioma were included after written informed consent and underwent preoperative diffusion tensor imaging in this prospective review-board approved study. Major white matter tracts in both hemispheres were tracked, segmented, and visually assessed for tumor involvement in thirty-four patients with gliomas grade II or III (astrocytomas or oligodendrogliomas) on postoperative neuropathological evaluation. Relative fractional anisotropy (rFA) and mean diffusivity (rMD) in tract segments were calculated and compared with visual evaluation and neuropathological diagnosis. Results. Tract segment infiltration on visual evaluation was associated with a lower rFA and high rMD in a majority of evaluated tract segments (89% and 78%, resp.). Grade II and grade III gliomas had similar infiltrating behavior. Conclusion. Quantitative MR tractography corresponds to visual evaluation of suspected tract infiltration. It may be useful for an objective preoperative evaluation of tract segment involvement.
authors.affiliation: Department of Surgical Sciences, Radiology, Uppsala University, 75105 Uppsala, Sweden; Department of Neuroradiology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institute, 17177 Stockholm, Sweden.
authors.forename: Anna F
authors.initials: AF
authors.lastname: Delgado
authors.affiliation: Bioimaging Center, Lund University, 22100 Lund, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, 75105 Uppsala, Sweden.
authors.forename: Francesco
authors.initials: F
authors.lastname: Latini
authors.affiliation: Department of Surgical Sciences, Radiology, Uppsala University, 75105 Uppsala, Sweden.
authors.forename: Johanna
authors.initials: J
authors.lastname: Mårtensson
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, 75105 Uppsala, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Zetterling
authors.affiliation: Department of Neuroscience, Neurology, Uppsala University, 75105 Uppsala, Sweden.
authors.forename: Shala G
authors.initials: SG
authors.lastname: Berntsson
authors.affiliation: Section of Pathology, Uppsala University Hospital and Department of Immunology, Genetics and Pathology, Uppsala University, 75105 Uppsala, Sweden.
authors.forename: Irina
authors.initials: I
authors.lastname: Alafuzoff
authors.affiliation: MR Department, Centre for Medical Imaging and Physiology, Lund University Hospital, 22185 Lund, Sweden.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Lätt
authors.affiliation: Department of Surgical Sciences, Radiology, Uppsala University, 75105 Uppsala, Sweden.
authors.forename: Elna-Marie
authors.initials: EM
authors.lastname: Larsson