Assessment of the corticospinal tract alterations before and after resection of brainstem lesions using Diffusion Tensor Imaging (DTI) and tractography at 3T

The purpose of the study was to investigate the role of Diffusion Tensor Imaging (DTI) and Diffusion Tensor Tractography (DTT) on the corticospinal tract alterations due to space occupying lesions in the brainstem before and after surgical resection. Pre- and post-surgical DTI data were acquired in...

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Bibliographic Details
Published in:European journal of radiology 2011-03, Vol.77 (3), p.383-391
Main Authors: Kovanlikaya, Ilhami, Firat, Zeynep, Kovanlikaya, Arzu, Uluğ, Aziz M, Cihangiroglu, M Mutlu, John, Majnu, Bingol, Canan Aykut, Ture, Ugur
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Brain Stem Neoplasms - pathology
Brain Stem Neoplasms - surgery
Diffusion Tensor Imaging - methods
Female
Humans
Male
Middle Aged
Preoperative Care - methods
Prognosis
Pyramidal Tracts - pathology
Treatment Outcome
Young Adult
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Summary:The purpose of the study was to investigate the role of Diffusion Tensor Imaging (DTI) and Diffusion Tensor Tractography (DTT) on the corticospinal tract alterations due to space occupying lesions in the brainstem before and after surgical resection. Pre- and post-surgical DTI data were acquired in 14 patients undergoing surgical resection of brainstem lesions. Patterns of corticospinal tract (CST) alteration on DTT were compared with the neurological exams of the patients pre- and post-operatively. DTT, especially in 3D movie format, seemed very helpful for evaluating the relationship of the lesions with the corticospinal tracts for surgical approach. None of the patients developed additional motor deficit related to surgery except one patient who presented with cerebellar ataxia after surgery. All of the patients with normal CST on DTT presented without motor deficit on neurological exam. The sensitivity, specificity, positive predictive and negative predictive values of DTT before surgery were 100%, 63.6%, 42.9% and 100%, and the corresponding values after surgery were 100%, 96%, 75% and 100% respectively. Although it has low specificity before surgery, DTT is a potentially useful technique in evaluating the effects of brainstem lesions and surgical resection on the relevant corticospinal tracts with high negative predictive value and higher specificity after surgery.
ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2009.08.012