BACKGROUND: Preoperative diffusion tensor imaging (DTI) is used to demonstrate corticospinal tract (CST) position. Intraoperative brain shifts may limit preoperative DTI value, and studies characterizing such shifts are lacking. OBJECTIVE: To examine tumor characteristics that could predict intraoperative shift in tumor-to-CST distance using high-field intraoperative magnetic resonance imaging. METHODS: We retrospectively evaluated preoperative and intraoperative DTIs, tumor pathology, and imaging characteristics of patients who underwent resection of an intra-axial tumor adjacent to the CST to identify covariates that significantly affected shift in tumor-to-CST distance. For validation, we analyzed data from a separate, 20-patient cohort. RESULTS: In the first cohort, the mean intraoperative shift in the tumor-to-CST distance was 3.18 ± 3.58 mm. The mean shift for the 20 patients with contrast and the 5 patients with non-contrast-enhancing tumors was 3.93 ± 3.64 and 0.18 ± 0.18 mm, respectively (P < .001). No association was found between intraoperative shift in tumor-to-CST distance and tumor pathology, tumor volume, edema volume, preoperative tumor-to-CST distance, or extent of resection. According to receiver-operating characteristic analysis, nonenhancement predicted a tumor-to-CST distance shift of ≤ 0.5 mm, with a sensitivity of 100% and a specificity of 75%. We validated these findings using the second cohort. CONCLUSION: For nonenhancing intra-axial tumors, preoperative DTI is a reliable method for assessing intraoperative tumor-to-CST distance because of minimal intraoperative shift, a finding that is important in the interpretation of subcortical motor evoked potential to maximize extent of resection and to preserve motor function. In resection of intra-axial enhancing tumors, intraoperative imaging studies are crucial to compensate for brain shift.
BACKGROUND: Preoperative diffusion tensor imaging (DTI) is used to demonstrate corticospinal tract (CST) position. Intraoperative brain shifts may limit preoperative DTI value, and studies characterizing such shifts are lacking. OBJECTIVE: To examine tumor characteristics that could predict intraoperative shift in tumor-to-CST distance using high-field intraoperative magnetic resonance imaging. METHODS: We retrospectively evaluated preoperative and intraoperative DTIs, tumor pathology, and imaging characteristics of patients who underwent resection of an intra-axial tumor adjacent to the CST to identify covariates that significantly affected shift in tumor-to-CST distance. For validation, we analyzed data from a separate, 20-patient cohort. RESULTS: In the first cohort, the mean intraoperative shift in the tumor-to-CST distance was 3.18 ± 3.58 mm. The mean shift for the 20 patients with contrast and the 5 patients with non-contrast-enhancing tumors was 3.93 ± 3.64 and 0.18 ± 0.18 mm, respectively (P < .001). No association was found between intraoperative shift in tumor-to-CST distance and tumor pathology, tumor volume, edema volume, preoperative tumor-to-CST distance, or extent of resection. According to receiver-operating characteristic analysis, nonenhancement predicted a tumor-to-CST distance shift of ≤ 0.5 mm, with a sensitivity of 100% and a specificity of 75%. We validated these findings using the second cohort. CONCLUSION: For nonenhancing intra-axial tumors, preoperative DTI is a reliable method for assessing intraoperative tumor-to-CST distance because of minimal intraoperative shift, a finding that is important in the interpretation of subcortical motor evoked potential to maximize extent of resection and to preserve motor function. In resection of intra-axial enhancing tumors, intraoperative imaging studies are crucial to compensate for brain shift.
Authors: Carolin Weiss; Irada Tursunova; Volker Neuschmelting; Hannah Lockau; Charlotte Nettekoven; Ana-Maria Oros-Peusquens; Gabriele Stoffels; Anne K Rehme; Andrea Maria Faymonville; N Jon Shah; Karl Josef Langen; Roland Goldbrunner; Christian Grefkes Journal: Neuroimage Clin Date: 2015-01-20 Impact factor: 4.881
Authors: Carolin Weiss Lucas; Irada Tursunova; Volker Neuschmelting; Charlotte Nettekoven; Ana-Maria Oros-Peusquens; Gabriele Stoffels; Andrea Maria Faymonville; Shah N Jon; Karl Josef Langen; Hannah Lockau; Roland Goldbrunner; Christian Grefkes Journal: Neuroimage Clin Date: 2016-11-23 Impact factor: 4.881