BACKGROUND Surgical treatment of diffuse glioma is performed to reduce tumor mass effect and to pave the way for adjuvant (chemo)radiotherapy. As a complication of surgery, ischemic lesions are often found in the postoperative setting. Not only can these lesion induce neurological deficits, but their volume has also been associated with reduced survival time. Prior studies suggest areas with a singular vascular supply to be more prone to postoperative ischemic lesions, although the precise cause is yet unknown. The aim of this study was to explore the volumetric and spatial distributions of postoperative ischemic lesions and their relation to arterial territories in glioma patients. MATERIAL AND METHODS We accessed a retrospective database of 144 adult cases with WHO grade II-IV supratentorial gliomas, who received surgery and postoperative MRI within 3 days in 2012–2014. We identified 93 patients with postoperative ischemia, defined as new confluent diffusion restriction on DWI. Ischemic lesions were manually delineated and spatially normalized to stereotaxic MNI space. Voxel-based analysis (VBA) was performed to compare presence and absence of postoperative ischemia. False positive results were eliminated by family-wise error correction. Areas of ischemia were labeled using an arterial territory map, the Harvard-Oxford cortical and subcortical atlases and the XTRACT white matter atlas. RESULTS Median volume of confluent ischemia was 3.52cc (IQR 2.15–5.94). 23 cases had only ischemic lesion in the left hemisphere, 46 in the right hemisphere and 24 bilateral. Median volume was 3.08cc (IQR 1.35–5.72) in left-sided lesions and 2.47cc (1.01–4.24) in right-sided lesions. Volume of ischemic lesions was not associated with survival after 1, 2 or 5 years. A cluster of 125.18cc was found to be significantly associated with development of postoperative ischemia. 73% of this cluster was situated in the arterial territory of the right middle cerebral artery (MCA), limited by the border of the posterior cerebral artery (PCA), and the watershed area between the right MCA and the right anterior cerebral artery (ACA). Significant areas were located in the frontal lobes, spanning into the right temporo-occipital region, and predominantly included right and left thalamus, caudate nucleus, putamen, pallidum, as well as right temporal gyri and insular cortex, and parts of the right corticospinal tract, longitudinal fasciculi and superior thalamic radiation. CONCLUSION We found slightly more and larger ischemic lesions in the right than left hemisphere after glioma resection. A statistically significant cluster of voxels of postoperative ischemia was found in the territory of the right MCA and watershed area of the right ACA. Exploration of the spatial distribution of these lesions could help elucidate their etiology and form the basis for predicting clinically relevant postoperative ischemia.

中文翻译：

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P14.30 弥漫性胶质瘤术后缺血空间分布的体素分析

背景技术对弥漫性神经胶质瘤进行手术治疗以减少肿瘤占位效应并为辅助（化学）放射治疗铺平道路。作为手术的并发症，缺血性病变经常出现在术后环境中。这些病变不仅会导致神经功能缺损，而且它们的体积也与存活时间缩短有关。先前的研究表明，具有单一血管供应的区域更容易发生术后缺血性病变，尽管确切原因尚不清楚。本研究的目的是探讨胶质瘤患者术后缺血性病变的体积和空间分布及其与动脉区域的关系。材料和方法 我们访问了一个包含 144 例 WHO II-IV 级幕上神经胶质瘤成人病例的回顾性数据库，2012-2014年3天内接受手术及术后MRI检查。我们确定了 93 名术后缺血患者，定义为 DWI 出现新的融合弥散受限。缺血性病变被手动描绘并在空间上标准化为立体定向 MNI 空间。进行基于体素的分析（VBA）来比较术后缺血的存在和不存在。通过家庭式纠错消除了假阳性结果。使用动脉区域图、Harvard-Oxford 皮质和皮质下图谱以及 XTRACT 白质图谱标记缺血区域。结果 汇合缺血的中位体积为 3.52cc (IQR 2.15–5.94)。仅左半球缺血23例，右半球46例，双侧24例。左侧病变的中位体积为 3.08cc (IQR 1.35–5.72)，中位体积为 2.47cc (1.01–4. 24) 在右侧病变中。缺血性病变的体积与 1、2 或 5 年后的生存率无关。发现一组 125.18cc 与术后缺血的发生显着相关。该簇的 73% 位于右大脑中动脉 (MCA) 的动脉区域，受大脑后动脉 (PCA) 边界以及右 MCA 和右大脑前动脉 (ACA) 之间的分水岭区域的限制）。重要区域位于额叶，跨越右侧颞枕区，主要包括左右丘脑、尾状核、壳核、苍白球，以及右侧颞回和岛叶皮质，以及部分右侧皮质脊髓束、纵束和上丘脑辐射。结论 胶质瘤切除后，我们发现右侧大脑半球的缺血性病变略多于左侧大脑半球。在右侧 MCA 区域和右侧 ACA 的分水岭区域发现了一组具有统计学意义的术后缺血体素。探索这些病变的空间分布有助于阐明其病因，并为预测临床相关的术后缺血奠定基础。