BACKGROUND An early maximal safe surgical resection is the current treatment paradigm for low-grade glioma (LGG). Nevertheless, there are no reliable methods to accurately predict the axonal intratumoral eloquent areas and, consequently, to predict the extent of resection. OBJECTIVE To describe the functional predictive value of eloquent white matter tracts within the tumor by using a pre- and postoperative intratumoral diffusion tensor imaging (DTI) tractography protocol in patients with LGG. METHODS A preoperative intratumoral DTI-based tractography protocol, using the tumor segmented volume as the only seed region, was used to assess the tracts within the tumor boundaries in 22 consecutive patients with LGG. The reconstructed tracts were correlated with intraoperative electrical stimulation (IES)-based language and motor subcortical mapping findings and the extent of resection was assessed by tumor volumetrics. RESULTS Identification of intratumoral language and motor tracts significantly predicted eloquent areas within the tumor during the IES mapping: the positive predictive value for the pyramidal tract, the inferior fronto-occipital fasciculus, the arcuate fasciculus and the inferior longitudinal fasciculus positive was 100%, 100%, 33%, and 80%, respectively, whereas negative predictive value was 100% for all of them. The reconstruction of at least one of these tracts within the tumor was significantly associated with a lower extent of resection (67%) as opposed to the extent of resection in the cases with a negative intratumoral tractography (100%) (P < .0001). CONCLUSION Intratumoral DTI-based tractography is a simple and reliable method, useful in assessing glioma resectability based on the analysis of intratumoral eloquent areas associated with motor and language tracts within the tumor.

中文翻译：

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通过使用肿瘤内牵引术检测肿瘤内的雄辩分束预测低级别胶质瘤的切除范围

背景 早期最大安全手术切除是目前低级别胶质瘤 (LGG) 的治疗范式。然而，没有可靠的方法来准确预测轴突瘤内雄辩区域，从而预测切除范围。目的 通过使用术前和术后肿瘤内扩散张量成像 (DTI) 纤维束成像方案描述 LGG 患者肿瘤内雄辩白质束的功能预测价值。方法 使用肿瘤分割体积作为唯一种子区域的术前瘤内 DTI 纤维束成像方案，用于评估 22 名连续 LGG 患者的肿瘤边界内的纤维束。重建的束与基于术中电刺激 (IES) 的语言和运动皮层下标测结果相关，切除的程度通过肿瘤体积进行评估。结果 肿瘤内语言和运动束的识别在 IES 映射期间显着预测了肿瘤内的雄辩区域：锥体束、下额枕束、弓状束和下纵束的阳性预测值为 100%，100 %、33% 和 80%，而所有这些的阴性预测值为 100%。与肿瘤内束成像阴性的病例中的切除范围 (100%) (P < .0001) 相比，在肿瘤内重建这些束中的至少一个与较低的切除范围 (67%) 显着相关。 . 结论 基于肿瘤内 DTI 的纤维束成像是一种简单可靠的方法，可用于基于肿瘤内与运动和语言束相关的肿瘤内表达区域的分析来评估胶质瘤的可切除性。