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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 476-483
DOI: 10.1055/s-0043-1772758
Original Article

Preoperative Diffusion Tensor Imaging in Supratentorial Intra-Axial Brain Tumors: Its Role in Predicting Tumor Histology and Prognosis as well in Surgical Planning and Resection

Authors

  • Ajay Singh

    1   Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India

  • Gaurav Jain

    1   Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India

  • Vinod Sharma

    1   Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India

  • Shaveta Singh

    1   Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India

Funding None.
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Abstract

Objective There are a large number of prospective studies that use diffusion tensor imaging (DTI) to show the relationship between intracranial tumors and white matter (WM) fibers. We studied the role of DTI in supratentorial intra-axial (ST-IA) tumors of the brain in deciding the surgical approach with maximal resection and minimal or no deficit and in predicting the histological characterization of the tumor and the neurological outcome.

Methods A total of 91 cases of ST-IA tumors were included in our study. The neurological status of the patients was assessed preoperatively, and the tumor volume and DTI pattern were noted radiologically. Surgical plan was decided by the senior consultants of the neurosurgery department taking into consideration the findings of tractography and magnetic resonance imaging. The neurological status and the extent of resection were evaluated postoperatively, and the correlation between histopathology with DTI was studied.

Results Of the 91 patients, 25 had high-grade glioma (HGG), 60 had low-grade glioma (LGG), and 6 were metastatic lesions. Gross total excisions were done mostly in patients with DTI showing displaced fibers and subtotal/partial resections were done mostly in disrupted/infiltrated tracts, which was statistically significant. The correlation between histopathology and tractography revealed that intact/displaced tracts were seen mostly in LGG (79%), whereas 86% of HGG showed disrupted/infiltrated fibers; both were statistically significant.

Conclusion Preoperative DTI in ST-IA brain tumors is an important tool for deciding the appropriate surgical approach for maximal safe resection, thus improving the post-op neurological outcome in patients. It also helps in predicting the tumor histology while also serving as an important prognostication indicator.

Keywords

diffusion tensor imaging - white matter - supratentorial intra-axial - low-grade glioma - high-grade glioma


Publication History

Article published online:
13 September 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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