The Pre-Surgical Planning of Brain Neoplasms: From Diffusion Tensor Imaging to More Advanced Approaches
Journal Title: Radiology – Open Journal - Year 2016, Vol 1, Issue 1
Abstract
The pre-surgical planning of brain neoplasms is strongly contributing to change the prognosis of neoplastic patients. Indeed, it supplies more and more detailed and reliable functional and morphological information before as well as during surgery. Both invasive and noninvasive approaches are available to achieve this goal. A powerful technique for the pre-surgical planning of brain neoplasms is Diffusion Weighted Imaging (DWI) based tractography. Differently from other approaches, tractography is able to provide, non-invasively, morphological information regarding brain pathways relationship with the neoplasm, by analyzing water diffusion within white matter. This is important especially for eloquent bundles, such as Cortico-Spinal Tract (CST) and Arcuate Fasciculus (AF), whose damages have a bad impact on the patient’s Quality of Life (QoL). Tractography can be performed through several diffusion signal modeling techniques, among which Diffusion Tensor Imaging (DTI) is the most known. DTI has been widely used for neurosurgery both in pre-operative and intra-operative contexts, also in combination with other functional approaches such as functional MRI (fMRI) and cortical stimulation.1-8 This useful technique was able to reduce post-surgical deficits as well as to improve the survival of neoplastic patients, through a better delineation of maximal safe resection.9 Moreover, its use provided great benefits in patients with high-grade gliomas in terms of risk of death.9 Several studies have demonstrated that DTI suffers from many limitations regarding its reliability to correctly model diffusion signal in different conditions.10,11 Furthermore, tensorial models are not able to resolve different fibers geometries (i.e. crossing fibers) within the same voxel; these complex configurations have been demonstrated to characterize more than 90% of white matter voxels,12 thus making DTI an unreliable diffusion modeling technique. In order to overcome these limitations, several other approaches were developed; in particular, High Angular Resolution Diffusion-weighted Imaging (HARDI),13 Q-Ball Imaging (QBI)14 and Diffusion Spectrum Imaging (DSI)15 were found to be promising techniques for resolving voxels with multiple fibers orientations.
Authors and Affiliations
Alessandro Arrigo
Keywords
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- EP ID EP553884
- DOI 10.17140/ROJ-1-e001
- Views 113
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The Pre-Surgical Planning of Brain Neoplasms: From Diffusion Tensor Imaging to More Advanced Approaches
The pre-surgical planning of brain neoplasms is strongly contributing to change the prognosis of neoplastic patients. Indeed, it supplies more and more detailed and reliable functional and morphological information befor...