Purpose

Diffusion tensor tractography (DTT) might reflect the postoperative clinical outcome of the patients with brain stem (BS) tumors correlating well with the neurological symptoms, but cavernous malformation (CM) is a hemorrhagic tumor prone to artifacts that may limit DTT. We set out to determine the correlation of DTT findings with the neurological examination before and after surgical resection in patients with BSCMs.

Materials and methods

DTT findings were evaluated bilaterally for fiber tract displacement or deviation, deformation and interruption in every patient before and after the surgery. Neurological examination was performed at admission, discharge and outpatient follow-up visit. The sensitivity, specificity, positive and negative predictive values of DTT were calculated both pre- and post-operatively.

Results

There were 25 patients (9 men 16 women) with a mean age of 39.5 ± 13.9 years. The mean size of the CMs was 6909 ± 8374 mm³ (range: 180–38,220 mm³) The mean follow-up time was 42.7 ± 23.2 months (range: 8 to 112 months). Preoperatively, the sensitivity, specificity, positive and negative predictive values of DTT for corticospinal tracts (CST) and medial lemnisci (ML) were 100%, 60%, 38.4%, 100% and 87.5%, 11.7%, 31.8%, 66.6%, respectively. Postoperatively, the sensitivity, specificity, positive and negative predictive values of DTT for CSTs and ML were 100%, 64.7%, 40%, 100% and 100%, 0%, 33.3%, 66.6%, respectively.

Conclusion

Positive findings on DTT such as fiber tract deviation, deformation, disruption or interruption should be taken cautiously before drawing conclusions of a clinically relevant damage of white matter tracts.

中文翻译：

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弥散张量纤维束成像在确定脑干海绵状血管畸形中临床相关白质损伤的有限阳性预测价值：一项单中心手术队列的回顾性研究

目的

弥散张量纤维束成像 (DTT) 可能反映脑干 (BS) 肿瘤患者的术后临床结果，与神经系统症状密切相关，但海绵状血管瘤 (CM) 是一种出血性肿瘤，容易出现可能限制 DTT 的伪影。我们着手确定 DTT 发现与 BSCM 患者手术切除前后神经系统检查的相关性。

材料和方法

对每位患者在手术前后的双侧纤维束位移或偏差、变形和中断进行 DTT 结果评估。在入院、出院和门诊随访时进行神经系统检查。术前和术后计算 DTT 的敏感性、特异性、阳性和阴性预测值。

结果

共有 25 名患者（9 男 16 女），平均年龄为 39.5  ±  13.9 岁。CM 的平均大小为 6909  ±  8374  mm ³（范围：180–38,220  mm ³） 平均随访时间为 42.7  ±  23.2 个月（范围：8 至 112 个月）。术前，DTT对皮质脊髓束（CST）和内侧淋巴管（ML）的敏感性、特异性、阳性和阴性预测值分别为100%、60%、38.4%、100%和87.5%、11.7%、31.8%、66.6% ， 分别。术后 DTT 对 CSTs 和 ML 的敏感性、特异性、阳性和阴性预测值分别为 100%、64.7%、40%、100% 和 100%、0%、33.3%、66.6%。

结论

在得出白质束临床相关损伤的结论之前，应谨慎对待 DTT 的阳性结果，例如纤维束偏离、变形、破坏或中断。