Along-tract analysis of DTI parameters in patients with gliomas and neuropsychological impairment.
Poster No:
1611
Submission Type:
Abstract Submission
Authors:
Francesco Latini1, Sadia Mirza1, Åsa Munkhammar2, Maria Zetterling1, Markus Fahlström3
Institutions:
1Department of medical Sciences, Neurosurgery. Uppsala University Hospital, Uppsala, Sweden, 2Rehabilitative medicine, Uppsala University Hospital, Uppsala, Sweden, 3Department of Surgical sciences, Radiology, Uppsala University, Uppsala, Sweden
First Author:
Francesco Latini
Department of medical Sciences, Neurosurgery. Uppsala University Hospital
Uppsala, Sweden
Department of medical Sciences, Neurosurgery. Uppsala University Hospital
Uppsala, Sweden
Co-Author(s):
Sadia Mirza
Department of medical Sciences, Neurosurgery. Uppsala University Hospital
Uppsala, Sweden
Department of medical Sciences, Neurosurgery. Uppsala University Hospital
Uppsala, Sweden
Maria Zetterling
Department of medical Sciences, Neurosurgery. Uppsala University Hospital
Uppsala, Sweden
Department of medical Sciences, Neurosurgery. Uppsala University Hospital
Uppsala, Sweden
Introduction:
Diffuse gliomas(DG) grade 2-3 show extensive infiltration through white matter(WM) tracts. Diffusion tensor tractography(DTI) with along-tract analysis (ATA) has been used to assess the microstructural integrity of WM pathways. The published results have been inconsistent, warranting further exploration into accuracy and possible limitation of this technique. We aimed to use ATA analysis to compare DTI parameters in DG and correlate them with preoperative neuropsychological assessment of patients with DG.
Methods:
Fourteen patients with IDH-mutated DG grade 2-3 were included. Tumour volumes were manually segmented on 3D-FLAIR images, spatially normalised to MNI space. DTI was acquired using a single-shot echo-planar sequence on a 3T with 48 sampling directions. DTI data was reconstructed within MNI space using q-space diffeomorphic reconstruction(QSDR) in DSI studio. Five bilateral sets of WM pathways(Frontal Aslant tract; Arcuate fasciculus; Inferior Fronto-Occipital Fasciculus; Cortico-spinal tract; and Cingulum), were reconstructed based on the HCP-1065 template. All WM pathways were stretched to the same length of 100 indices and FA, RD, AD, MD and QA were sampled for each index. An overlay of tumour 3D reconstruction was used to detect contact with WM pathways. Contralateral and not affected WM pathways were considered normal and included as normal data. WM pathways were compared individually and per index to the normal data using a z-test. False discovery rate was controlled using the Benjamini-Hochberg procedure with Q = 10%. Preoperative neuropsychological assessment (attention and working memory, processing speed, learning and long-term memory both verbal and visual, visuospatial construction, and executive functioning) was performed in all the subjects and correlated to results from ATA.
Results:
Eleven (78.6%) of the patients presented epilepsy and 6 (42.9%) presented preoperative neuropsychological impairment. When tumour was in contact with the WM pathways abnormalities were detected in infiltrated bundles at z-test in 13 patients. AD and FA were the most sensitive DTI parameters. Tumour volume (Tv), the tumour infiltration per voxel (TIv) and tumour extension (Te) along the pathway were successfully displayed with topographical details on the each graph together with DTI parameter. Abnormal AD, RD, MD and FA correlated with Tv, TIv and Te (p <.001). The presence of preoperative neuropsychological impairment was correlated with higher AD (p .04), lower QA (p .005), higher TIv (p .01) and Te (p .03).
Conclusions:
ATA analysis is a sensitive and reliable method to detect DTI abnormalities but also the extension of WM infiltration in patients with DG. Quantitative and qualitative DTI abnormalities were correlated with preoperative neuropsychological impairment. ATA may be valuable for longitudinal controls after the preoperative assessment, surgical planning or for implementing tailored radiotherapy treatment.
Higher Cognitive Functions:
Higher Cognitive Functions Other
Modeling and Analysis Methods:
Diffusion MRI Modeling and Analysis 1
Methods Development 2
Keywords:
Data analysis
Neoplastic Disease
STRUCTURAL MRI
Tractography
White Matter
WHITE MATTER IMAGING - DTI, HARDI, DSI, ETC
1|2Indicates the priority used for review
Provide references using author date format
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