Object: The objective is to evaluate the role of diffusion tensor imaging (DTI) in
intra-axial brain tumor cases (gliomas and metastasis). To preoperatively assess the
integrity and location of white matter (WM) tracts and plan the surgical corridor
to cause least damage to the WM tracts with minimum postoperative new neurological
deficits. Materials and Methods: A total of 34 patients were included in this study. Pre-operative contrast-enhanced
magnetic resonance imaging and DTI scans of the patients were taken into consideration.
Pre- and post-operative neurological examinations were performed and the outcome was
assessed. Results: Preoperative planning of surgical corridor and extent of resection were planned so
that maximum possible resection could be achieved without disturbing the WM tracts.
DTI indicated the involvement of fiber tracts. A total of 21 (61.7%) patients had
a displacement of tracts only and they were not invaded by tumor. A total of 11 (32.3%)
patients had an invasion of tracts by the tumor, whereas in 4 (11.7%) patients the
tracts were disrupted. Postoperative neurologic examination revealed deterioration
of motor power in 4 (11.7%) patients, deterioration of language function in 3 (8.82%)
patients, and memory in one patient. Total resection was achieved in 11/18 (61.1%)
patients who had displacement of fibers, whereas it was achieved in 5/16 (31.2%) patients
when there was infiltration/disruption of tracts. Conclusion: DTI provides crucial information regarding the infiltration of the tract and their
displaced course due to the tumor. This study indicates that it is a very important
tool for the preoperative planning of surgery. The involvement of WM tracts is a strong
predictor of the surgical outcome.
Key-words:
Diffusion tensor image - intra-axial brain tumor - magnetic resonance image - tractography
- white matter tracts
