Towards a tractography-based risk stratification model for language area associated gliomas

Autor: Luca Francesco Salvati, Juliane Hardt, Katharina Faust, Mehmet Salih Tuncer, Lucius S. Fekonja, Ralph Schilling, Thomas Picht, Luca L Silva, Ulrike Grittner, Peter Vajkoczy, Tizian Rosenstock, Ina Bährend
Rok vydání: 2021
Předmět:
lcsh:RC346-429
0302 clinical medicine
Neural Pathways
Arcuate fasciculus
Language
biology
05 social sciences
Regular Article
Glioma
Diffusionsgewichtete Magnetresonanztomografie
Diffusion Tensor Imaging
medicine.anatomical_structure
Neurology
DTI
lcsh:R858-859.7
Radiology
medicine.symptom
Tractography
medicine.medical_specialty
Cognitive Neuroscience
Brain tumor
Uncinate fasciculus
lcsh:Computer applications to medicine. Medical informatics
Risk Assessment
behavioral disciplines and activities
Language pathways
050105 experimental psychology
White matter
03 medical and health sciences
Aphasie
Aphasia
mental disorders
Fasciculus
medicine
Humans
0501 psychology and cognitive sciences
Radiology
Nuclear Medicine and imaging
ddc:610
Inferior longitudinal fasciculus
Risk stratification
lcsh:Neurology. Diseases of the nervous system
business.industry
Hirntumor
biology.organism_classification
medicine.disease
nervous system diseases
Gliom
610 Medizin
Gesundheit
nervous system
Neurology (clinical)
business
030217 neurology & neurosurgery
Zdroj: NeuroImage: Clinical, Vol 29, Iss, Pp 102541-(2021)
NeuroImage : Clinical
ISSN: 2213-1582
Popis: Highlights • Injury to major white matter pathways during language-area associated glioma surgery often results in permanent aphasia. • DTI-based tractography of language pathways allows to correlate individual tract injury profiles with functional outcome. • Infiltration of the AF is particularly associated with functional deterioration. • The temporo-parieto-occipital junction and the temporal stem were confirmed as pivotal functional nodes. • Standardized DTI-based tractography can help to determine the individual aphasia risk profile before surgery.
Objectives Injury to major white matter pathways during language-area associated glioma surgery often leads to permanent loss of neurological function. The aim was to establish standardized tractography of language pathways as a predictor of language outcome in clinical neurosurgery. Methods We prospectively analyzed 50 surgical cases of patients with left perisylvian, diffuse gliomas. Standardized preoperative Diffusion-Tensor-Imaging (DTI)-based tractography of the 5 main language tracts (Arcuate Fasciculus [AF], Frontal Aslant Tract [FAT], Inferior Fronto-Occipital Fasciculus [IFOF], Inferior Longitudinal Fasciculus [ILF], Uncinate Fasciculus [UF]) and spatial analysis of tumor and tracts was performed. Postoperative imaging and the resulting resection map were analyzed for potential surgical injury of tracts. The language status was assessed preoperatively, postoperatively and after 3 months using the Aachen Aphasia Test and Berlin Aphasia Score. Correlation analyses, two-step cluster analysis and binary logistic regression were used to analyze associations of tractography results with language outcome after surgery. Results In 14 out of 50 patients (28%), new aphasic symptoms were detected 3 months after surgery. The preoperative infiltration of the AF was associated with functional worsening (cc = 0.314; p = 0.019). Cluster analysis of tract injury profiles revealed two areas particularly related to aphasia: the temporo-parieto-occipital junction (TPO; temporo-parietal AF, middle IFOF, middle ILF) and the temporal stem/peri-insular white matter (middle IFOF, anterior ILF, temporal UF, temporal AF). Injury to these areas (TPO: OR: 23.04; CI: 4.11 – 129.06; temporal stem: OR: 21.96; CI: 2.93 – 164.41) was associated with a higher-risk of persisting aphasia. Conclusions Tractography of language pathways can help to determine the individual aphasia risk profile pre-surgically. The TPO and temporal stem/peri-insular white matter were confirmed as functional nodes particularly sensitive to surgical injuries.
Databáze: OpenAIRE
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