Role of diffusion tensor magnetic resonance tractography in predicting the extent of resection in glioma surgery

Antonella Castellano, Lorenzo Bello, Caterina Michelozzi, Marcello Gallucci, Enrica Fava, Antonella Iadanza, Marco Riva, Giuseppe Casaceli, Andrea Falini

Research output: Contribution to journalArticlepeer-review


Diffusion tensor imaging (DTI) tractography enables the in vivo visualization of the course of white matter tracts inside or around a tumor, and it provides the surgeon with important information in resection planning. This study is aimed at assessing the ability of preoperative DTI tractography in predicting the extent of the resection achievable in surgical removal of gliomas. Patients with low-grade gliomas (LGGs; 46) and high-grade gliomas (HGGs; 27) were studied using a 3T scanner according to a protocol including a morphological study (T2, fluid-attenuated inversion-recovery, T1 sequences) and DTI acquisitions (b 1000 s/mm 2, 32 gradient directions). Preoperative tractography was performed off-line on the basis of a streamline algorithm, by reconstructing the inferior fronto-occipital (IFO), the superior longitudinal fascicle (SLF), and the corticospinal tract (CST). For each patient, the relationship between each bundle reconstructed and the lesion was analyzed. Initial and residual tumor volumes were measured on preoperative and postoperative 3D fluid-attenuated inversion-recovery images for LGGs and postcontrast T1-weighted scans for HGGs. The presence of intact fascicles was predictive of a better surgical outcome, because these cases showed a higher probability of total resection than did subtotal and partial resection. The presence of infiltrated or displaced CST or infiltrated IFO was predictive of a lower probability of total resection, especially for tumors with preoperative volume 3. DTI tractography can thus be considered to be a promising tool for estimating preoperatively the degree of radicality to be reached by surgical resection. This information will aid clinicians in identifying patients who will mostly benefit from surgery.

Original languageEnglish
Pages (from-to)192-202
Number of pages11
Issue number2
Publication statusPublished - Feb 2012


  • Diffusion tensor imaging
  • DTI tractography
  • extent of resection
  • glioma surgery
  • presurgical planning

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Clinical Neurology


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