Article
Diffusion tensor imaging based fiber tracking in glioma surgery
Diffusions-Tensor-Bildgebung-gestütztes Fibertracking in der Gliomchirurgie
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Authors
Published: | April 23, 2004 |
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Outline
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Objective
To visualize the localization of white matter tracts based on diffusion tensor imaging (DTI) applying intraoperative high-field magnetic resonance imaging (MRI).
Methods
A 1.5T Magnetom Sonata (Siemens Medical Solutions, Erlangen, Germany) was used for pre- and intraoperative imaging. For DTI echo-planar imaging (6 diffusion directions, high b value 1000 s/mm2, matrix 128 x 128, FOV 240 mm) was used. Fiber tracking for 3-D visualization was generated by definition a ROI of corresponding voxels with similar fractional anisotropy. Corresponding 3-D views of pre- and intraoperative fiber tract data were displayed for visualization of brain shift. In 13 patients color-encoded fractional anisotropy maps of DTI data were integrated into the navigation setup.
Results
Intraoperative DTI was technically feasible in 31 patients undergoing glioma surgery. Side by side display of corresponding 3-D views of fiber tract data depicted a marked shifting of white matter tracts during glioma removal. This brain shift of deep structures emphasizes the need for an intraoperative update of navigation systems, when navigation is applied during resection of deep-seated tumor portions near eloquent brain areas. Integration of DTI fractional anisotropy maps into the navigation datasets was successful; we did not observe new neurological deficits in these patients despite extended resections.
Conclusions
Comparing pre- and intraoperative 3-D fiber tracts based on DTI visualizes a marked shifting of major white matter tracts during glioma resection. DTI-based neuronavigation with intraoperative image updating allowed a preservation of neurological function in surgery of gliomas adjacent to major white matter tracts.