Yuqiang Yao1, Nils H Ulrich2, Roman Guggenberger3, Yahea A Alzarhani3, Helmut Bertalanffy4, Spyros S Kollias3. 1. Department of Neuroradiology, University Hospital, University of Zurich, Zurich, Switzerland; Department of Neurosurgery, Beijing Jishuitan Hospital, Beijing, China. Electronic address: yuqiangyao@gmail.com. 2. Department of Neuroradiology, University Hospital, University of Zurich, Zurich, Switzerland; Department of Neurosurgery, University Hospital, University of Zurich, Zurich, Switzerland. 3. Department of Neuroradiology, University Hospital, University of Zurich, Zurich, Switzerland. 4. Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany.
Abstract
OBJECTIVE: In this study, we investigated the potential prognostic role of morphologic and quantitative diffusion tensor imaging (DTI) in patients with brainstem cavernoma (BSC) in terms of postoperative outcome. METHODS: In this retrospective study of 14 brainstem cavernoma patients, we analyzed pre- and postoperative DTI data. White matter tractography of corticospinal tracts (CSTs) was performed with the Fiber Assignment by Continuous Tracking algorithm, and morphologic characteristics of CSTs were compared with clinically assessed motor strength. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured in ipsi- and contralesional regions of interest at the lesion level, as well as levels caudal and rostral to the lesion. Correlation analysis was performed between lateral index (LI) of ipsi-/contralateral FA and ADC values and patients' motor function. RESULTS: Preoperatively, normal morphologic features of CSTs corresponded to normal motor function in 4 patients. The other 10 morphologically abnormal preoperative CSTs didn't show corresponding motor impairment either in pre- or postoperative follow-up period. The sensitivity, specificity, positive predictive, and negative predictive values of white matter tractographic morphology on preoperative motor function were 100%, 57.1%, 70%, and 100%, respectively. The corresponding values on follow-up motor function were 100%, 33.3%, 20%, and 100%, respectively. The mean FA at lesion level was significantly lower than the corresponding FA at the contralateral hemisphere (P = 0.009). In areas caudal to the lesion the same trend yet without statistic significance was observed (P = 0.23). There was no significant laterality difference of mean FAs rostral to the level of the lesion. No correlation in LI of FA or ADC in the 3 anatomic levels with simultaneous and long-term follow up motor function was observed. Restoration of the morphology of the affected CST postoperatively was associated with a trend for decreasing ADC compared with the preoperative measurements. CONCLUSION: Intact CST morphology in DTI predicts a favorable postoperative outcome in patients with BSC. Interrupted CSTs and decreased FA values correlate well within BSC lesion level; nevertheless, morphologic characteristics and diffusion parameter changes at lesion level cannot predict poor prognosis. Caudal and rostral diffusion parameters can provide more information of the integrity of CSTs compared with morphologic study alone.
OBJECTIVE: In this study, we investigated the potential prognostic role of morphologic and quantitative diffusion tensor imaging (DTI) in patients with brainstem cavernoma (BSC) in terms of postoperative outcome. METHODS: In this retrospective study of 14 brainstem cavernomapatients, we analyzed pre- and postoperative DTI data. White matter tractography of corticospinal tracts (CSTs) was performed with the Fiber Assignment by Continuous Tracking algorithm, and morphologic characteristics of CSTs were compared with clinically assessed motor strength. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured in ipsi- and contralesional regions of interest at the lesion level, as well as levels caudal and rostral to the lesion. Correlation analysis was performed between lateral index (LI) of ipsi-/contralateral FA and ADC values and patients' motor function. RESULTS: Preoperatively, normal morphologic features of CSTs corresponded to normal motor function in 4 patients. The other 10 morphologically abnormal preoperative CSTs didn't show corresponding motor impairment either in pre- or postoperative follow-up period. The sensitivity, specificity, positive predictive, and negative predictive values of white matter tractographic morphology on preoperative motor function were 100%, 57.1%, 70%, and 100%, respectively. The corresponding values on follow-up motor function were 100%, 33.3%, 20%, and 100%, respectively. The mean FA at lesion level was significantly lower than the corresponding FA at the contralateral hemisphere (P = 0.009). In areas caudal to the lesion the same trend yet without statistic significance was observed (P = 0.23). There was no significant laterality difference of mean FAs rostral to the level of the lesion. No correlation in LI of FA or ADC in the 3 anatomic levels with simultaneous and long-term follow up motor function was observed. Restoration of the morphology of the affected CST postoperatively was associated with a trend for decreasing ADC compared with the preoperative measurements. CONCLUSION: Intact CST morphology in DTI predicts a favorable postoperative outcome in patients with BSC. Interrupted CSTs and decreased FA values correlate well within BSC lesion level; nevertheless, morphologic characteristics and diffusion parameter changes at lesion level cannot predict poor prognosis. Caudal and rostral diffusion parameters can provide more information of the integrity of CSTs compared with morphologic study alone.
Authors: Herwin Speckter; Jose Bido; Giancarlo Hernandez; Diones Rivera; Luis Suazo; Santiago Valenzuela; Cesar Gonzalez; Peter Stoeter Journal: J Radiosurg SBRT Date: 2019
Authors: Sergio Garcia-Garcia; Sofia Kakaizada; Laura Oleaga; Arnau Benet; Jordina Rincon-Toroella; José Juan González-Sánchez Journal: Neurol India Date: 2019 May-Jun Impact factor: 2.117