Reconstruction of the Corticospinal Tract in Patients with Motor-Eloquent High-Grade Gliomas Using Multilevel Fiber Tractography Combined with Functional Motor Cortex Mapping

A. Zhylka (Corresponding author), N. Sollmann, F. Kofler, A. Radwan, A. De Luca, J. Gempt, B. Wiestler, B. Menze, A. Schroeder, C. Zimmer, J.S. Kirschke, S. Sunaert, A. Leemans, S.M. Krieg, J. Pluim

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Abstract

BACKGROUND AND PURPOSE: Tractography of the corticospinal tract is paramount to presurgical planning and guidance of intraoperative resection in patients with motor-eloquent gliomas. It is well-known that DTI-based tractography as the most frequently used technique has relevant shortcomings, particularly for resolving complex fiber architecture. The purpose of this study was to evaluate multilevel fiber tractography combined with functional motor cortex mapping in comparison with conventional deterministic tractography algorithms. MATERIALS AND METHODS: Thirty-one patients (mean age, 61.5 [SD, 12.2] years) with motor-eloquent high-grade gliomas underwent MR imaging with DWI (TR/TE ¼ 5000/78 ms, voxel size ¼ 2 × 2 × 2 mm3, 1 volume at b ¼ 0 s/mm2, 32 volumes at b ¼ 1000 s/mm2). DTI, constrained spherical deconvolution, and multilevel fiber tractography–based reconstruction of the corticospinal tract within the tumor-affected hemispheres were performed. The functional motor cortex was enclosed by navigated transcranial magnetic stimulation motor mapping before tumor resection and used for seeding. A range of angular deviation and fractional anisotropy thresholds (for DTI) was tested. RESULTS: For all investigated thresholds, multilevel fiber tractography achieved the highest mean coverage of the motor maps (eg, angular threshold = 60°; multilevel/constrained spherical deconvolution/DTI, 25% anisotropy threshold ¼ 71.8%, 22.6%, and 11.7%) and the most extensive corticospinal tract reconstructions (eg, angular threshold ¼ 60°; multilevel/constrained spherical deconvolution/DTI, 25% anisotropy threshold ¼ 26,485 mm3, 6308 mm3, and 4270 mm3). CONCLUSIONS: Multilevel fiber tractography may improve the coverage of the motor cortex by corticospinal tract fibers compared with conventional deterministic algorithms. Thus, it could provide a more detailed and complete visualization of corticospinal tract architecture, particularly by visualizing fiber trajectories with acute angles that might be of high relevance in patients with gliomas and distorted anatomy.

Original languageEnglish
Pages (from-to)283-290
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume44
Issue number3
DOIs
Publication statusPublished - 1 Mar 2023

Bibliographical note

Funding Information:
Andrey Zhylka received funding from the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 765148. Bjoern Menze, Benedikt Wiestler, and Florian Kofler are supported through the SFB 824, subproject B12, supported by Deutsche Forschungsgemeinschaft through Technical University of Munich International Graduate School of Science and Engineering, GSC 81.

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